Provider Demographics
NPI:1336471556
Name:GOGA, ALLAN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:M
Last Name:GOGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:17550 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2006
Mailing Address - Country:US
Mailing Address - Phone:708-922-1588
Mailing Address - Fax:708-922-0116
Practice Address - Street 1:17550 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2006
Practice Address - Country:US
Practice Address - Phone:708-922-1588
Practice Address - Fax:708-922-0116
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051030693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist