Provider Demographics
NPI:1174806251
Name:MACHETTA, CHRISTOPHER D (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:MACHETTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-9314
Mailing Address - Country:US
Mailing Address - Phone:815-795-9698
Mailing Address - Fax:815-795-9698
Practice Address - Street 1:100 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1441
Practice Address - Country:US
Practice Address - Phone:815-941-1284
Practice Address - Fax:815-941-1462
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist