Provider Demographics
NPI:1467891697
Name:ALLGOOD, THERESA K (BS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:K
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2581
Mailing Address - Country:US
Mailing Address - Phone:847-543-9106
Mailing Address - Fax:847-543-9124
Practice Address - Street 1:885 E BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2581
Practice Address - Country:US
Practice Address - Phone:847-543-9106
Practice Address - Fax:847-543-9124
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist