Provider Demographics
NPI:1356428130
Name:CARRILLO, JORGE D (PHARMD, MS, BCPS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:D
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:PHARMD, MS, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 ORANGERY CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-871-1042
Mailing Address - Fax:
Practice Address - Street 1:1 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4294
Practice Address - Country:US
Practice Address - Phone:630-792-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH27941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy