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General NPI Number Information
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NPI Number | 1336426337
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Entity Type | Individual
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Provider Name | MR. HOWARD WAYNE SIEGEL
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Gender | Male
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 12700 W ROCKLAND
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City | LAKE BLUFF
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State | IL
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Zip | 60044
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Country | US
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Telephone | 847-615-2088
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Fax | 847-615-2177
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Provider Business Mailing Address
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Address Line | 790 SHERIDAN ROAD
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City | GLENCOE
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State | IL
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Zip | 60022-1363
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Country | US
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Telephone | 847-835-1566
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Fax | 847-835-0356
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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 | 051028862
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License Number State | IL
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