MEDICARE: DR. NNEKA COS-OKPALLA PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13818	WI

General Provider Information

NPI Number	:	1407975568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NNEKA COS-OKPALLA PHARM.D.

Provider Business Mailing Address
First Line	:	4521 W TUCKER LN
Second Line	:
City	:	WAUKEGAN
State	:	IL
Zip	:	60085-8606
Country	:	US
Telephone Number	:	847-620-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 LAKE COOK ROAD
Second Line	:	MS L#444
City	:	DEERFIELD
State	:	IL
Zip	:	60015-5238
Country	:	US
Telephone Number	:	847-964-6545
Fax Number	:	847-374-2669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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