Provider Demographics
NPI:1215210711
Name:ORIE, KALU BASSEY (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:KALU
Middle Name:BASSEY
Last Name:ORIE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 E 92ND STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:773-721-6603
Mailing Address - Fax:773-721-2003
Practice Address - Street 1:2924 E 92ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-721-6603
Practice Address - Fax:773-721-2003
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033507183500000X
TX29225183500000X
IN26091877A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist