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General NPI Number Information
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NPI Number | 1033458005
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Entity Type | Individual
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Provider Name | JESUS ROJO
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Gender | Male
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 6723 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2216
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Country | US
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Telephone | 708-317-5313
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Fax | 708-317-5316
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Provider Business Mailing Address
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Address Line | 5317 W 24TH ST 2ND FLOOR
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City | CICERO
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State | IL
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Zip | 60804-2832
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Country | US
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Telephone | 708-656-0218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.295441
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License Number State | IL
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