Provider Demographics
NPI:1710224522
Name:CASTRODALE, PATRICIA A
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:CASTRODALE
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 1:1075 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IL
Mailing Address - Zip Code:62341
Mailing Address - Country:US
Mailing Address - Phone:217-847-2214
Mailing Address - Fax:217-847-6681
Practice Address - Street 1:1075 BROADWAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IL
Practice Address - Zip Code:62341
Practice Address - Country:US
Practice Address - Phone:217-847-2214
Practice Address - Fax:217-847-6681
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16049183500000X
IN051033053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist