Healthcare Provider Details

I. General information

NPI: 1720203052
Provider Name (Legal Business Name): JOHN OH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

542 PEREGRINE PKWY
BARTLETT IL
60103-1238
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-1312
  • Fax: 312-996-8525
Mailing address:
  • Phone: 847-691-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: