Provider Demographics
NPI:1295788396
Name:ANSELMO, ROBERT JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ANSELMO
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 1:5943 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1629
Mailing Address - Country:US
Mailing Address - Phone:847-508-3197
Mailing Address - Fax:716-558-1765
Practice Address - Street 1:5943 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1629
Practice Address - Country:US
Practice Address - Phone:847-508-3197
Practice Address - Fax:716-558-1765
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510337581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy