Healthcare Provider Details

I. General information

NPI: 1023865755
Provider Name (Legal Business Name): BRANDON NICHOLAS LENGEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-4722
  • Fax:
Mailing address:
  • Phone: 224-610-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number21435
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: