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General NPI Number Information
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NPI Number | 1467857235
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Entity Type | Individual
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Provider Name | ERIC CORRAO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 6430 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482
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Country | US
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Telephone | 708-448-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 17633 OAKWOOD DRIVE
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City | TINLEY PARK
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State | IL
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Zip | 60487
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Country | US
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Telephone | 636-699-7257
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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 | 051.297999
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2013043623
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License Number State | MO
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