Provider Demographics
NPI:1265511760
Name:GORACIO, ANTONIO P (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:P
Last Name:GORACIO
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 BENNINGTON LN
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-9007
Mailing Address - Country:US
Mailing Address - Phone:815-363-0365
Mailing Address - Fax:
Practice Address - Street 1:28835 N HERKY DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1465
Practice Address - Country:US
Practice Address - Phone:847-680-0688
Practice Address - Fax:847-680-0692
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist