Provider Demographics
NPI:1639451701
Name:MUSCOLINO, JOHN J (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MUSCOLINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4249
Mailing Address - Country:US
Mailing Address - Phone:708-780-7513
Mailing Address - Fax:
Practice Address - Street 1:5840 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4249
Practice Address - Country:US
Practice Address - Phone:708-780-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.036042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist