Provider Demographics
NPI:1790226868
Name:AIWOHI, CHALSEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHALSEA
Middle Name:
Last Name:AIWOHI
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 1:1345 1/2 W TOUHY AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2674
Mailing Address - Country:US
Mailing Address - Phone:808-336-1278
Mailing Address - Fax:
Practice Address - Street 1:1345 1/2 W TOUHY AVE
Practice Address - Street 2:APT 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2674
Practice Address - Country:US
Practice Address - Phone:808-336-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist