Provider Demographics
NPI:1982759858
Name:WASSILAK, CHARLES F (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
Last Name:WASSILAK
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 1:1100E. EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-0000
Mailing Address - Country:US
Mailing Address - Phone:708-672-9175
Mailing Address - Fax:
Practice Address - Street 1:1100 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-3433
Practice Address - Country:US
Practice Address - Phone:708-672-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist