Angelica Aurora Disterhoft, PHARMD
Individual provider Active NPI Pharmacist · Geneseo, IL
NPI 1316214539 · NPPES record last updated Nov 17, 2011
Key facts
- NPI
- 1316214539
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.290198 (IL)
- Practice address
- 1009 S Oakwood Ave
Geneseo, IL 61254-1937 - Phone
- (309) 944-3784
- Fax
- (309) 944-2768
- NPI assigned
- Nov 17, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.290198 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.290198 | IL | Yes |
Addresses
Primary practice location
1009 S Oakwood Ave
Geneseo, IL 61254-1937
Mailing address
1009 S Oakwood Ave
Geneseo, IL 61254-1937
Phone (309) 944-3784
Other providers in Geneseo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2011. 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.