Provider Demographics
NPI:1770866980
Name:PANOZZO, ALBERT JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:JAMES
Last Name:PANOZZO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25901 N RIVERWOODS RD
Mailing Address - Street 2:
Mailing Address - City:METTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3403
Mailing Address - Country:US
Mailing Address - Phone:847-235-1309
Mailing Address - Fax:847-235-1306
Practice Address - Street 1:25901 N RIVERWOODS RD
Practice Address - Street 2:
Practice Address - City:METTAWA
Practice Address - State:IL
Practice Address - Zip Code:60045-3403
Practice Address - Country:US
Practice Address - Phone:847-235-1309
Practice Address - Fax:847-235-1306
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051028832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist