Provider Demographics
NPI:1063502268
Name:GURGONE, MARK ANTHONY (RPH, BCNP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:GURGONE
Suffix:
Gender:M
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2510
Mailing Address - Country:US
Mailing Address - Phone:815-782-4743
Mailing Address - Fax:
Practice Address - Street 1:161 TOWER DR
Practice Address - Street 2:UNIT A
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5776
Practice Address - Country:US
Practice Address - Phone:630-321-0218
Practice Address - Fax:630-321-0345
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2866471835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear