Provider Demographics
NPI:1487780276
Name:MASCARELLO, JOHN J
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:MASCARELLO
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 1:7545 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-9305
Mailing Address - Country:US
Mailing Address - Phone:708-532-7711
Mailing Address - Fax:
Practice Address - Street 1:7545 159TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-9305
Practice Address - Country:US
Practice Address - Phone:708-532-7711
Practice Address - Fax:708-532-1524
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist