Provider Demographics
NPI:1528164761
Name:KOSSIFOLOGOS, ANNETTE CHRISTINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:CHRISTINE
Last Name:KOSSIFOLOGOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:CHRISTINE
Other - Last Name:ROTELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:211 LONGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1417
Mailing Address - Country:US
Mailing Address - Phone:708-421-1772
Mailing Address - Fax:
Practice Address - Street 1:EDWARD HINES JR. VAMC, FIFTH AVENUE AND ROOSEVELT ROAD
Practice Address - Street 2:BUILDING 200 ROOM B 128 H, PHARMACY SERVICE (119)
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291357183500000X
IL0512913571835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist