Provider Demographics
NPI:1447850474
Name:ADJOKATCHER, PHYLLIS ASOR
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ASOR
Last Name:ADJOKATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:ASOR
Other - Last Name:OWUSU-AFRIYIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 WAKE ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1716
Mailing Address - Country:US
Mailing Address - Phone:630-674-5089
Mailing Address - Fax:
Practice Address - Street 1:420 S WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6531
Practice Address - Country:US
Practice Address - Phone:815-439-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist