Healthcare Provider Details

I. General information

NPI: 1639255573
Provider Name (Legal Business Name): BARRYNINC DBA LESON DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5364 W DEVON AVE
CHICAGO IL
60646-4143
US

IV. Provider business mailing address

5364 WEST DEVON AVE
CHICAGO IL
60646
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-6090
  • Fax: 773-774-7677
Mailing address:
  • Phone: 773-774-6090
  • Fax: 773-774-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. HARVEY NADICK
Title or Position: PRESIDENT
Credential: R.PH
Phone: 773-774-6090