Provider Demographics
NPI:1083983365
Name:INGOGLIA, ZAGORKA
Entity Type:Individual
Prefix:MRS
First Name:ZAGORKA
Middle Name:
Last Name:INGOGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-5156
Mailing Address - Country:US
Mailing Address - Phone:219-922-6292
Mailing Address - Fax:
Practice Address - Street 1:22 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1202
Practice Address - Country:US
Practice Address - Phone:219-865-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016580A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist