Provider Demographics
NPI:1760706642
Name:KROHN, PAMELA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:KROHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ALDON RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1902
Mailing Address - Country:US
Mailing Address - Phone:630-801-1471
Mailing Address - Fax:
Practice Address - Street 1:1900 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2419
Practice Address - Country:US
Practice Address - Phone:630-896-3000
Practice Address - Fax:630-896-2056
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist