Provider Demographics
NPI:1336650803
Name:EROGBOGBO, ADEBOLA U (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:U
Last Name:EROGBOGBO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4647
Mailing Address - Country:US
Mailing Address - Phone:815-282-2077
Mailing Address - Fax:
Practice Address - Street 1:5900 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4647
Practice Address - Country:US
Practice Address - Phone:815-282-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist