Provider Demographics
NPI:1114394699
Name:SOMMERCORN, CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SOMMERCORN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N WAUKEGAN RD
Mailing Address - Street 2:PHARMACY SOLUTIONS AP5 NE
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-1802
Mailing Address - Country:US
Mailing Address - Phone:847-937-2567
Mailing Address - Fax:
Practice Address - Street 1:1 N WAUKEGAN RD
Practice Address - Street 2:PHARMACY SOLUTIONS AP5 NE
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-1802
Practice Address - Country:US
Practice Address - Phone:847-937-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist