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General NPI Number Information
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NPI Number | 1063502268
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Entity Type | Individual
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Provider Name | MARK ANTHONY GURGONE RPH., BCNP
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 161 TOWER DR UNIT A
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City | BURR RIDGE
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State | IL
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Zip | 60527-5776
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Country | US
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Telephone | 630-321-0218
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Fax | 630-321-0345
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Provider Business Mailing Address
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Address Line | 7606 RED OAK DR
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City | PLAINFIELD
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State | IL
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Zip | 60586-2510
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Country | US
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Telephone | 815-782-4743
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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 | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 051.286647
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License Number State | IL
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