Provider Demographics
NPI:1144984774
Name:MONTELONGO, MICHAEL (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MONTELONGO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S DEE RD APT D
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3733
Mailing Address - Country:US
Mailing Address - Phone:847-772-8927
Mailing Address - Fax:
Practice Address - Street 1:5625 N RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3434
Practice Address - Country:US
Practice Address - Phone:773-989-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist