Provider Demographics
NPI:1720434368
Name:TUMMINARO, JOHN PAUL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:TUMMINARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 KIRK RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4723
Mailing Address - Country:US
Mailing Address - Phone:630-587-0847
Mailing Address - Fax:
Practice Address - Street 1:652 KIRK RD
Practice Address - Street 2:PHARMACY
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4723
Practice Address - Country:US
Practice Address - Phone:630-587-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist