Provider Demographics
NPI:1861088106
Name:PROKOPIOS, PATRICIA JOANNE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOANNE
Last Name:PROKOPIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1303
Mailing Address - Country:US
Mailing Address - Phone:630-620-2690
Mailing Address - Fax:
Practice Address - Street 1:350 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1303
Practice Address - Country:US
Practice Address - Phone:630-620-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-288453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371414552Medicaid