Provider Demographics
NPI:1497356596
Name:DALOGDOG, HOSANNAH MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOSANNAH MARIE
Middle Name:
Last Name:DALOGDOG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:DALOGDOG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 N LINDEN ST APT J305
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5346
Mailing Address - Country:US
Mailing Address - Phone:312-593-9945
Mailing Address - Fax:
Practice Address - Street 1:2225 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-5014
Practice Address - Country:US
Practice Address - Phone:309-828-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513031862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer