Provider Demographics
NPI:1124628946
Name:MAKAREWICZ, CAROL A (RPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MAKAREWICZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 W HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1657
Mailing Address - Country:US
Mailing Address - Phone:618-632-9381
Mailing Address - Fax:618-632-1673
Practice Address - Street 1:1530 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1657
Practice Address - Country:US
Practice Address - Phone:618-632-9381
Practice Address - Fax:618-632-1673
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist