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General NPI Number Information
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NPI Number | 1093184079
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Entity Type | Individual
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Provider Name | CARIZZA CALUPAS CAMPOSANO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/19/2015
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Provider Practice Location Address
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Address Line | 1200 E WAR MEMORIAL DR
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City | PEORIA
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State | IL
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Zip | 61616-7723
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Country | US
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Telephone | 309-682-3844
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 W ALTA RD 2206
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City | PEORIA
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State | IL
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Zip | 61615-1279
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Country | US
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Telephone |
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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 | 051.299013
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License Number State | IL
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