Provider Demographics
NPI:1396013553
Name:PORCARO, CHARLOTTE A (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:A
Last Name:PORCARO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10S370 KINGERY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4418
Mailing Address - Country:US
Mailing Address - Phone:630-655-2733
Mailing Address - Fax:
Practice Address - Street 1:10S370 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-6140
Practice Address - Country:US
Practice Address - Phone:630-655-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2908211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist