Provider Demographics
NPI:1871876334
Name:TASSONE, BENJAMIN A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:TASSONE
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 1:5359 S NORDICA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1017
Mailing Address - Country:US
Mailing Address - Phone:312-607-0041
Mailing Address - Fax:773-254-9632
Practice Address - Street 1:3798 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1014
Practice Address - Country:US
Practice Address - Phone:773-254-6383
Practice Address - Fax:773-254-9632
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist