Healthcare Provider Details

I. General information

NPI: 1548177074
Provider Name (Legal Business Name): JUSTIN LUKE VELASCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 E OGDEN AVE
NAPERVILLE IL
60563-1603
US

IV. Provider business mailing address

1299 E OGDEN AVE
NAPERVILLE IL
60563-1603
US

V. Phone/Fax

Practice location:
  • Phone: 630-548-2057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.309408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: