Provider Demographics
NPI:1013390202
Name:MOJICA, EVERARDO JESUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVERARDO
Middle Name:JESUS
Last Name:MOJICA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 W GIDDINGS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5739
Mailing Address - Country:US
Mailing Address - Phone:773-715-0919
Mailing Address - Fax:
Practice Address - Street 1:6525 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2312
Practice Address - Country:US
Practice Address - Phone:773-804-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.201057183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician