Provider Demographics
NPI:1871196881
Name:LAGOS, ALESSANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:
Last Name:LAGOS
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 1:3276 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5123
Mailing Address - Country:US
Mailing Address - Phone:312-351-0135
Mailing Address - Fax:
Practice Address - Street 1:936 WILLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6822
Practice Address - Country:US
Practice Address - Phone:847-291-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist