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General NPI Number Information
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NPI Number | 1396028007
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Entity Type | Individual
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Provider Name | GEORGE HESEQIAL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 5158 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2521
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Country | US
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Telephone | 773-907-8490
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Fax |
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Provider Business Mailing Address
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Address Line | 3755 CLIFFORD TER
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City | SKOKIE
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State | IL
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Zip | 60076-2846
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Country | US
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Telephone | 773-919-0976
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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 | 051289131
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License Number State | IL
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