Provider Demographics
NPI:1700406915
Name:YEMOH, EMMANUEL O (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:YEMOH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4611
Mailing Address - Country:US
Mailing Address - Phone:773-252-7769
Mailing Address - Fax:
Practice Address - Street 1:4650 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-4611
Practice Address - Country:US
Practice Address - Phone:773-252-7769
Practice Address - Fax:773-252-7795
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist