Provider Demographics
NPI:1700901469
Name:SOWA, DENNIS JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOSEPH
Last Name:SOWA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 E DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-4022
Mailing Address - Country:US
Mailing Address - Phone:630-833-9555
Mailing Address - Fax:
Practice Address - Street 1:42 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2345
Practice Address - Country:US
Practice Address - Phone:630-512-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist