Healthcare Provider Details

I. General information

NPI: 1114927423
Provider Name (Legal Business Name): JOHN PARISE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16170 KINGSPORT RD
ORLAND PARK IL
60467-5602
US

IV. Provider business mailing address

16170 KINGSPORT RD
ORLAND PARK IL
60467-5602
US

V. Phone/Fax

Practice location:
  • Phone: 708-259-4719
  • Fax: 708-349-9792
Mailing address:
  • Phone: 708-259-4719
  • Fax: 708-349-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051034213
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051034213
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number212000160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: