Healthcare Provider Details

I. General information

NPI: 1114179520
Provider Name (Legal Business Name): GERALD B HANDLER R PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 W ADAMS ST
CHICAGO IL
60612-3201
US

IV. Provider business mailing address

1657 W ADAMS ST
CHICAGO IL
60612-3201
US

V. Phone/Fax

Practice location:
  • Phone: 312-327-6157
  • Fax: 312-377-7983
Mailing address:
  • Phone: 312-327-6157
  • Fax: 312-377-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-023033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: