Provider Demographics
NPI:1194841965
Name:ROGOWIN, MARK ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:ROGOWIN
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 1:2620 W BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1404
Mailing Address - Country:US
Mailing Address - Phone:773-381-4630
Mailing Address - Fax:
Practice Address - Street 1:2620 W BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1404
Practice Address - Country:US
Practice Address - Phone:773-381-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist