Healthcare Provider Details

I. General information

NPI: 1154212116
Provider Name (Legal Business Name): AGNIESZKA ALICJA OBORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WILMOT RD, MS #2002
DEERFIELD IL
60015
US

IV. Provider business mailing address

246 GREGORY M SEARS DR
GILBERTS IL
60136-4024
US

V. Phone/Fax

Practice location:
  • Phone: 847-315-2500
  • Fax:
Mailing address:
  • Phone: 630-400-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051307132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: