Healthcare Provider Details

I. General information

NPI: 1619259231
Provider Name (Legal Business Name): MICHELLE STOGA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 09/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 N CUMBERLAND AVE
NORRIDGE IL
60706-2914
US

IV. Provider business mailing address

1322 N ILLINOIS AVE
ARLINGTON HEIGHTS IL
60004-4443
US

V. Phone/Fax

Practice location:
  • Phone: 708-583-2133
  • Fax:
Mailing address:
  • Phone: 847-788-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051286058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: