Individual
MRS. ANGELICA AURORA DISTERHOFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1009 S OAKWOOD AVE, GENESEO, IL 61254-1937
(309) 944-3784
(309) 944-2768
Mailing address
1009 S OAKWOOD AVE, GENESEO, IL 61254-1937
(309) 944-3784
(309) 944-2768
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.290198
IL
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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