Provider Demographics
NPI:1598045007
Name:VOGT, COLLEEN MARY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:VOGT
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 1:810 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2051
Mailing Address - Country:US
Mailing Address - Phone:847-426-1773
Mailing Address - Fax:847-426-1778
Practice Address - Street 1:810 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2051
Practice Address - Country:US
Practice Address - Phone:847-426-1773
Practice Address - Fax:847-426-1778
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist