Provider Demographics
NPI:1285092379
Name:GONCHARENKO, ALEXANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GONCHARENKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S WOOD ST, RM 164 (MC 886)
Mailing Address - Street 2:UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF PHARMACY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-1366
Mailing Address - Fax:312-996-0379
Practice Address - Street 1:833 S WOOD ST RM 164
Practice Address - Street 2:UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7229
Practice Address - Country:US
Practice Address - Phone:312-996-1366
Practice Address - Fax:312-996-0379
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist