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General NPI Number Information
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NPI Number | 1033725346
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Entity Type | Individual
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Provider Name | KACEE JO GOULD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 5758 S MARYLAND AVE STE 510
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City | CHICAGO
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State | IL
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Zip | 60637-1426
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Country | US
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Telephone | 773-834-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 5758 S MARYLAND AVE STE 510
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City | CHICAGO
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State | IL
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Zip | 60637-1426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | A1-0015514
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2019025953
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051303375
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License Number State | IL
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