Provider Demographics
NPI:1548588205
Name:ILONZO, CHIMDIMMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHIMDIMMA
Middle Name:
Last Name:ILONZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2850
Mailing Address - Country:US
Mailing Address - Phone:610-544-4645
Mailing Address - Fax:610-544-1757
Practice Address - Street 1:1154 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2850
Practice Address - Country:US
Practice Address - Phone:610-544-4645
Practice Address - Fax:610-544-1757
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442458OtherPA BOARD OF PHARMACY