MEDICARE: LEELAND GOODHEART PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.291549	IL

General Provider Information

NPI Number	:	1609151265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELAND GOODHEART PHARM D

Provider Business Mailing Address
First Line	:	4040 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1807
Country	:	US
Telephone Number	:	773-283-5321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1807
Country	:	US
Telephone Number	:	773-283-5321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	10/14/2011

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Directions to “ LEELAND GOODHEART PHARM D” Practice Location

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