Provider Demographics
NPI:1851415897
Name:IMMERGLUCK, ALLEN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:M
Last Name:IMMERGLUCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:770 S BUFFALO GROVE RD
Mailing Address - Street 2:DOMINICKS PHARMACY
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3708
Mailing Address - Country:US
Mailing Address - Phone:847-459-7704
Mailing Address - Fax:847-459-8146
Practice Address - Street 1:770 S BUFFALO GROVE RD
Practice Address - Street 2:DOMINICKS PHARMACY
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3708
Practice Address - Country:US
Practice Address - Phone:847-459-7704
Practice Address - Fax:847-459-8146
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist