Provider Demographics
NPI:1467857235
Name:CORRAO, ERIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:CORRAO
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 1:17633 OAKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487
Mailing Address - Country:US
Mailing Address - Phone:636-699-7257
Mailing Address - Fax:
Practice Address - Street 1:6430 W 111TH ST
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482
Practice Address - Country:US
Practice Address - Phone:708-448-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297999183500000X
MO2013043623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist