Provider Demographics
NPI:1417291584
Name:CORSO, MARY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CORSO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 N DEARBORN ST
Mailing Address - Street 2:APT 806
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3127
Mailing Address - Country:US
Mailing Address - Phone:312-613-6090
Mailing Address - Fax:
Practice Address - Street 1:1036 N DEARBORN ST
Practice Address - Street 2:APT 806
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3127
Practice Address - Country:US
Practice Address - Phone:312-613-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist