Provider Demographics
NPI:1992932107
Name:KOCH, ROSEMARIE ELEANA (RPH)
Entity type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:ELEANA
Last Name:KOCH
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 1:1343 W GREENLEAF AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2916
Mailing Address - Country:US
Mailing Address - Phone:773-262-4169
Mailing Address - Fax:
Practice Address - Street 1:1343 W GREENLEAF AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2916
Practice Address - Country:US
Practice Address - Phone:773-262-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist