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General NPI Number Information
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NPI Number | 1073125845
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Entity Type | Individual
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Provider Name | AISOSA DEBORAH OKPOGIE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 11 E 75TH ST
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City | CHICAGO
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State | IL
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Zip | 60619-1601
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Country | US
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Telephone | 773-224-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 RUSSELL DR
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-4583
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Country | US
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Telephone | 510-589-8650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 051300041
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License Number State | IL
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