Healthcare Provider Details

I. General information

NPI: 1124398359
Provider Name (Legal Business Name): ADWOA ARNONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W ROOSEVELT RD
CHICAGO IL
60624-4339
US

IV. Provider business mailing address

2231 W MAYPOLE AVE UNIT 202
CHICAGO IL
60612-2696
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-1232
  • Fax:
Mailing address:
  • Phone: 517-410-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051291669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: