Individual
ALLEN DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4041 VETERANS DR, 4041 VETERANS DR, OTTAWA, IL 61350-9602
(815) 434-0176
(815) 434-0176
Mailing address
4041 VETERANS DR, OTTAWA, IL 61350-9602
(815) 434-0176
(815) 434-0176
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-029805
IL
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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