Individual
JASON BUGNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, PHD
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1443
(773) 702-2374
Mailing address
1601 S INDIANA AVE APT 214, CHICAGO, IL 60616-1397
(847) 772-9966
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051303066
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051303066
STATE LICENSE
IL
Enumeration date
09/30/2020
Last updated
11/27/2023
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