Provider Demographics
NPI:1881011344
Name:DINGILLO, LORETTA
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:DINGILLO
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 1:3516 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-9208
Mailing Address - Country:US
Mailing Address - Phone:708-204-9732
Mailing Address - Fax:630-985-9467
Practice Address - Street 1:2317 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2302
Practice Address - Country:US
Practice Address - Phone:630-985-5383
Practice Address - Fax:630-985-9467
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist