Healthcare Provider Details

I. General information

NPI: 1770866980
Provider Name (Legal Business Name): ALBERT JAMES PANOZZO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25901 N RIVERWOODS RD
METTAWA IL
60045-3403
US

IV. Provider business mailing address

25901 N RIVERWOODS RD
METTAWA IL
60045-3403
US

V. Phone/Fax

Practice location:
  • Phone: 847-235-1309
  • Fax: 847-235-1306
Mailing address:
  • Phone: 847-235-1309
  • Fax: 847-235-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051028832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: