Provider Demographics
NPI:1548443120
Name:SCALZITTI, LEONARD PAUL
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:PAUL
Last Name:SCALZITTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CONNAMARA CT
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2771
Mailing Address - Country:US
Mailing Address - Phone:630-209-0689
Mailing Address - Fax:773-585-3531
Practice Address - Street 1:5525 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4417
Practice Address - Country:US
Practice Address - Phone:773-585-3434
Practice Address - Fax:773-585-3531
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist