Provider Demographics
NPI:1376133371
Name:CALIOLIO, ALYSSA NADINE
Entity Type:Individual
Prefix:
First Name:ALYSSA NADINE
Middle Name:
Last Name:CALIOLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1545
Mailing Address - Country:US
Mailing Address - Phone:309-266-5396
Mailing Address - Fax:309-263-8103
Practice Address - Street 1:1005 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1545
Practice Address - Country:US
Practice Address - Phone:309-266-5396
Practice Address - Fax:309-263-8103
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist