Individual
MRS. CONNIE JEAN FOGG-JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12290 S PULASKI RD, ALSIP, IL 60803-1405
(708) 385-2006
(708) 385-3124
Mailing address
12290 S PULASKI RD, ALSIP, IL 60803-1405
(708) 385-2006
(708) 385-3124
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051036254
IL
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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