1285092379 NPI number — ALEXANDRA GONCHARENKO PHARM.D.

Table of content: ALEXANDRA GONCHARENKO PHARM.D. (NPI 1285092379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285092379 NPI number — ALEXANDRA GONCHARENKO PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONCHARENKO
Provider First Name:
ALEXANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285092379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 S WOOD ST, RM 164 (MC 886)
Provider Second Line Business Mailing Address:
UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF PHARMACY
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-1366
Provider Business Mailing Address Fax Number:
312-996-0379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 S WOOD ST RM 164
Provider Second Line Business Practice Location Address:
UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF PHARMACY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-1366
Provider Business Practice Location Address Fax Number:
312-996-0379
Provider Enumeration Date:
02/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051.297668 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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