Vito Bottalico, DOCTOR OF PHARMACY
Individual provider Active NPI Pharmacist · Villa Park, IL
NPI 1164870879 · NPPES record last updated Jun 3, 2016
Key facts
- NPI
- 1164870879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.039136 (IL)
- Practice address
- 31 St. Charles
Villa Park, IL 60181 - Phone
- (630) 279-8900
- Fax
- (630) 279-0182
- NPI assigned
- Jun 3, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.039136 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.039136 | IL | Yes |
Addresses
Primary practice location
31 St. Charles
Villa Park, IL 60181
Mailing address
31 St. Charles
Villa Park, IL 60181
Phone (630) 279-8900
Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.