Provider Demographics
NPI:1265454458
Name:CARAVELLO, SCOTT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:J
Last Name:CARAVELLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434-1022
Mailing Address - Country:US
Mailing Address - Phone:309-932-2084
Mailing Address - Fax:
Practice Address - Street 1:120 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:GALVA
Practice Address - State:IL
Practice Address - Zip Code:61434-1710
Practice Address - Country:US
Practice Address - Phone:309-932-3440
Practice Address - Fax:309-932-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist