Healthcare Provider Details

I. General information

NPI: 1457170318
Provider Name (Legal Business Name): NICO ANTONIO CONFUORTO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICO ANTONIO WASERSZTRUM

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 BUSSE HWY
PARK RIDGE IL
60068-3252
US

IV. Provider business mailing address

481 BUSSE HWY
PARK RIDGE IL
60068-3294
US

V. Phone/Fax

Practice location:
  • Phone: 847-696-3680
  • Fax: 847-696-0411
Mailing address:
  • Phone: 847-696-3680
  • Fax: 847-696-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051306659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: