Provider Demographics
NPI:1477764355
Name:ALLGOOD, MARC E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:ALLGOOD
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 1:22362 LONG GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3737
Mailing Address - Country:US
Mailing Address - Phone:847-438-3110
Mailing Address - Fax:847-916-4806
Practice Address - Street 1:3030 CULLERTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2205
Practice Address - Country:US
Practice Address - Phone:847-916-4713
Practice Address - Fax:847-916-4806
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51290088183500000X
IA18555183500000X
NE10693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist