Individual
CHARLIE WIT DEJSAHRAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
641 N CLARK ST, CHICAGO, IL 60654-3796
(312) 587-1416
Mailing address
641 N CLARK ST, CHICAGO, IL 60654-3796
(312) 587-1416
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.292813
IL
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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