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General NPI Number Information
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NPI Number | 1831484450
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Entity Type | Individual
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Provider Name | GARY DEAN LEVATO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 7300 191ST ST T-2035
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City | TINLEY PARK
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State | IL
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Zip | 60487-9361
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Country | US
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Telephone | 815-806-3211
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Fax | 815-806-3221
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Provider Business Mailing Address
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Address Line | 7300 191ST ST T-2035
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City | TINLEY PARK
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State | IL
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Zip | 60487-9361
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Country | US
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Telephone | 815-806-3211
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Fax | 815-806-3221
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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 | 051.292920
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License Number State | IL
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