Provider Demographics
NPI:1194264291
Name:DAGAMAC, BRIAN (PHARM D)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DAGAMAC
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-1138
Mailing Address - Country:US
Mailing Address - Phone:630-422-8002
Mailing Address - Fax:
Practice Address - Street 1:818 THORNDALE AVE
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1138
Practice Address - Country:US
Practice Address - Phone:630-422-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist