Healthcare Provider Details

I. General information

NPI: 1508534983
Provider Name (Legal Business Name): CLIFFORD CASTILLO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 W 95TH ST
EVERGREEN PARK IL
60805-2809
US

IV. Provider business mailing address

2559 W 95TH ST
EVERGREEN PARK IL
60805-2809
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-2056
  • Fax: 708-422-2032
Mailing address:
  • Phone: 708-422-2056
  • Fax: 773-422-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051304104
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051304104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: