Healthcare Provider Details

I. General information

NPI: 1154239614
Provider Name (Legal Business Name): ELENI FEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N 4TH AVE
DES PLAINES IL
60016-2303
US

IV. Provider business mailing address

9 N 4TH AVE
DES PLAINES IL
60016-2303
US

V. Phone/Fax

Practice location:
  • Phone: 312-709-5536
  • Fax:
Mailing address:
  • Phone: 312-709-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: