Healthcare Provider Details

I. General information

NPI: 1689359002
Provider Name (Legal Business Name): MARICRUZ CASAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E IRVING PARK RD
ITASCA IL
60143-2300
US

IV. Provider business mailing address

353 S LA PORTE CT
ADDISON IL
60101-3977
US

V. Phone/Fax

Practice location:
  • Phone: 630-875-0244
  • Fax:
Mailing address:
  • Phone: 630-863-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305482
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: