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General NPI Number Information
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NPI Number | 1649354341
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Entity Type | Individual
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Provider Name | ELJIM PATRICK TESORO PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST MC 883, SUITE C300
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 18032 S SPRING MEADOWS DR
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City | MOKENA
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State | IL
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Zip | 60448-9598
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 51285941
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License Number State | IL
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