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General NPI Number Information
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NPI Number | 1164021614
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Entity Type | Individual
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Provider Name | LEANNA GRYZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2020
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 5501 S HALSTED ST STE 147
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City | CHICAGO
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State | IL
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Zip | 60621-2229
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Country | US
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Telephone | 773-359-8570
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Fax | 773-359-8571
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Provider Business Mailing Address
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Address Line | 11111 S KEAN AVE APT 101
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City | PALOS HILLS
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State | IL
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Zip | 60465-3106
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Country | US
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Telephone | 708-897-4102
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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 | 051289192
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License Number State | IL
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