Provider Demographics
NPI:1063010585
Name:CALDERON, CLARISSA I (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:I
Last Name:CALDERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7053 W 64TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4632
Mailing Address - Country:US
Mailing Address - Phone:773-225-6589
Mailing Address - Fax:
Practice Address - Street 1:4740 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2530
Practice Address - Country:US
Practice Address - Phone:708-425-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist