Provider Demographics
NPI:1427898626
Name:JAGMIN, DONNA B (RPH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:JAGMIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SOUTH BUTTERNUT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-545-7070
Mailing Address - Fax:
Practice Address - Street 1:INGALLS PROFESSIONAL PHARMACY
Practice Address - Street 2:71 W. 156TH STREET
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-4306
Practice Address - Fax:708-915-2095
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.030425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist