Provider Demographics
NPI:1578845020
Name:FIGUEROA, JUAN J
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4131
Mailing Address - Country:US
Mailing Address - Phone:773-254-3316
Mailing Address - Fax:773-254-1263
Practice Address - Street 1:3045 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4131
Practice Address - Country:US
Practice Address - Phone:773-254-3316
Practice Address - Fax:773-254-1263
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-287923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist