Healthcare Provider Details

I. General information

NPI: 1295754380
Provider Name (Legal Business Name): CARAVELLO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EXCHANGE ST
GALVA IL
61434-1710
US

IV. Provider business mailing address

120 EXCHANGE ST
GALVA IL
61434-1710
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054011103
License Number StateIL

VIII. Authorized Official

Name: MR. SCOTT J CARAVELLO
Title or Position: PRESIDENT/PHARMACY MANAGER
Credential: R.PH.
Phone: 309-932-3440