Provider Demographics
NPI:1457170318
Name:CONFUORTO, NICO ANTONIO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICO
Middle Name:ANTONIO
Last Name:CONFUORTO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICO
Other - Middle Name:ANTONIO
Other - Last Name:WASERSZTRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 N JAMEY LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1177 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3952
Practice Address - Country:US
Practice Address - Phone:630-629-5050
Practice Address - Fax:630-629-5057
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist