Healthcare Provider Details

I. General information

NPI: 1235739012
Provider Name (Legal Business Name): MICHAEL GOULD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 RUNNING BROOK FARM BLVD
JOHNSBURG IL
60051-5425
US

IV. Provider business mailing address

583 MACARTHUR DR
BUFFALO GROVE IL
60089-3420
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-7702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2018013604
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23145
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03337302
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051303311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: