Individual
AISOSA DEBORAH OKPOGIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
11 E 75TH ST, CHICAGO, IL 60619-1601
(773) 224-1211
Mailing address
1520 RUSSELL DR, HOFFMAN ESTATES, IL 60192-4583
(510) 589-8650
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
051300041
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314228594
—
IL
Enumeration date
08/21/2020
Last updated
08/21/2020
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