Provider Demographics
NPI:1437273414
Name:DORFMAN, IRWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:
Last Name:DORFMAN
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 1:1703 KOEHLING RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1300
Mailing Address - Country:US
Mailing Address - Phone:847-562-1041
Mailing Address - Fax:
Practice Address - Street 1:2748 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1481
Practice Address - Country:US
Practice Address - Phone:847-864-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist