Provider Demographics
NPI:1114514593
Name:WARGO, ARTHUR GEORGE
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:GEORGE
Last Name:WARGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S HADDEN RD
Mailing Address - Street 2:
Mailing Address - City:MAZON
Mailing Address - State:IL
Mailing Address - Zip Code:60444-6266
Mailing Address - Country:US
Mailing Address - Phone:815-343-0519
Mailing Address - Fax:
Practice Address - Street 1:2510 S HADDEN RD
Practice Address - Street 2:
Practice Address - City:MAZON
Practice Address - State:IL
Practice Address - Zip Code:60444-6266
Practice Address - Country:US
Practice Address - Phone:815-343-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty