Provider Demographics
NPI:1700075959
Name:BAJON, CHARLENE ARLENE (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ARLENE
Last Name:BAJON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NORTHWEST HWY
Mailing Address - Street 2:DOMINICK'S PHARMACY
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1208
Mailing Address - Country:US
Mailing Address - Phone:847-516-8476
Mailing Address - Fax:847-516-8506
Practice Address - Street 1:800 NORTHWEST HWY
Practice Address - Street 2:DOMINICK'S PHARMACY
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1208
Practice Address - Country:US
Practice Address - Phone:847-516-8476
Practice Address - Fax:847-516-8506
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist