Provider Demographics
NPI:1508274143
Name:GAMMARIELLO RX INC
Entity Type:Organization
Organization Name:GAMMARIELLO RX INC
Other - Org Name:KATSAROS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-288-8700
Mailing Address - Street 1:1521 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4509
Mailing Address - Country:US
Mailing Address - Phone:773-288-8700
Mailing Address - Fax:773-288-7963
Practice Address - Street 1:1521 E 53RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4509
Practice Address - Country:US
Practice Address - Phone:773-288-8700
Practice Address - Fax:773-288-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid