Provider Demographics
NPI:1215536123
Name:PRATO, MILES VINCENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:VINCENT
Last Name:PRATO
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 1:8715 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1905
Mailing Address - Country:US
Mailing Address - Phone:708-598-2511
Mailing Address - Fax:708-598-2174
Practice Address - Street 1:8715 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1985
Practice Address - Country:US
Practice Address - Phone:708-598-2511
Practice Address - Fax:708-598-2174
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist