Provider Demographics
NPI:1013283142
Name:SORISHO, JOE A (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:A
Last Name:SORISHO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 N EAST PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1010
Mailing Address - Country:US
Mailing Address - Phone:224-616-0677
Mailing Address - Fax:
Practice Address - Street 1:7139 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4424
Practice Address - Country:US
Practice Address - Phone:847-647-6422
Practice Address - Fax:847-647-6520
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371414552034Medicaid