Individual
ALBERTO A DISTAOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1050 WAUKEGAN RD, NORTHBROOK, IL 60062-3700
(847) 272-3155
Mailing address
1050 WAUKEGAN RD, NORTHBROOK, IL 60062-3700
(847) 272-3155
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051041039
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051041039
PHARMACY LISCENSE
IL
Enumeration date
08/28/2011
Last updated
08/28/2011
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