Healthcare Provider Details

I. General information

NPI: 1497736888
Provider Name (Legal Business Name): THOMAS CARL GOCHENOUR PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE SUITE 1600
OAK PARK IL
60304-1091
US

IV. Provider business mailing address

390 REPTON RD
RIVERSIDE IL
60546-1620
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-6822
  • Fax: 708-660-6821
Mailing address:
  • Phone: 708-442-6624
  • Fax: 708-660-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: