Healthcare Provider Details

I. General information

NPI: 1265454458
Provider Name (Legal Business Name): SCOTT J CARAVELLO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EXCHANGE ST
GALVA IL
61434-1710
US

IV. Provider business mailing address

104 NW 5TH ST
GALVA IL
61434-1022
US

V. Phone/Fax

Practice location:
  • Phone: 309-932-3440
  • Fax: 309-932-3220
Mailing address:
  • Phone: 309-932-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: