Provider Demographics
NPI:1689359002
Name:CASAS, MARICRUZ
Entity Type:Individual
Prefix:
First Name:MARICRUZ
Middle Name:
Last Name:CASAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 S LA PORTE CT
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3977
Mailing Address - Country:US
Mailing Address - Phone:630-863-2446
Mailing Address - Fax:
Practice Address - Street 1:1325 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2300
Practice Address - Country:US
Practice Address - Phone:630-875-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist