Healthcare Provider Details

I. General information

NPI: 1548588205
Provider Name (Legal Business Name): CHIMDIMMA ILONZO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

IV. Provider business mailing address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-4645
  • Fax: 610-544-1757
Mailing address:
  • Phone: 610-544-4645
  • Fax: 610-544-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442458
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: