Provider Demographics
NPI:1316231590
Name:ORANGE, GARY ALAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:ORANGE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S RANDALL RD
Mailing Address - Street 2:T-1801
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5915
Mailing Address - Country:US
Mailing Address - Phone:847-458-5341
Mailing Address - Fax:847-458-5341
Practice Address - Street 1:750 S RANDALL RD
Practice Address - Street 2:T-1801
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5915
Practice Address - Country:US
Practice Address - Phone:847-458-5341
Practice Address - Fax:847-458-5341
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist