Healthcare Provider Details

I. General information

NPI: 1679850762
Provider Name (Legal Business Name): MRS. LEIZLA GELABERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE ST
MAYWOOD IL
60153-1685
US

IV. Provider business mailing address

100 LAKE ST
MAYWOOD IL
60153-1685
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-9885
  • Fax: 708-344-8450
Mailing address:
  • Phone: 708-344-9885
  • Fax: 708-344-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051040568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: