Active NPI
Odessa G Ubongen
- Pharmacist
- Evanston, IL
National Provider Identifier
1700210457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051296986
- Practice address
- 1910 Dempster St
Evanston, IL 60202-1016 - Phone
- (847) 866-9233
- NPI assigned
- Aug 29, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051296986 | IL | Primary |
Addresses
Primary practice location
1910 Dempster St
Evanston, IL 60202-1016
Mailing address
8804 Briar CT Apt 2a
Des Plaines, IL 60016-5414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051296986 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377734400000",
"number": "1700210457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8804 BRIAR CT APT 2A",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600165414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 DEMPSTER ST",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602021016",
"telephone_number": "847-866-9233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UBONGEN",
"first_name": "ODESSA",
"middle_name": "G",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-29",
"last_updated": "2013-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051296986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.