Provider Demographics
NPI:1245714930
Name:WALDVOGEL, CURTIS MATTHEW (PHARMD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:MATTHEW
Last Name:WALDVOGEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7908
Mailing Address - Country:US
Mailing Address - Phone:630-464-5909
Mailing Address - Fax:630-596-1488
Practice Address - Street 1:1751 W DIEHL RD STE 110
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4912
Practice Address - Country:US
Practice Address - Phone:630-799-1595
Practice Address - Fax:630-596-1488
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist