Healthcare Provider Details

I. General information

NPI: 1336424068
Provider Name (Legal Business Name): LEIGHANNE SILVERIO POON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEIGHANNE SILVERIO PHARMD

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16261 S BOULEVARD PL
PLAINFIELD IL
60586-4400
US

IV. Provider business mailing address

16261 S BOULEVARD PL UNIT 1
PLAINFIELD IL
60586-4400
US

V. Phone/Fax

Practice location:
  • Phone: 815-676-1170
  • Fax:
Mailing address:
  • Phone: 815-676-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.293966
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: