Healthcare Provider Details

I. General information

NPI: 1780307363
Provider Name (Legal Business Name): DAVID GONZALEZ LUNA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N ASHLAND AVE
CHICAGO IL
60657-8905
US

IV. Provider business mailing address

163 RED OAK ST
POPLAR GROVE IL
61065-8512
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-4155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051304998
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: