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General NPI Number Information
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NPI Number | 1780577171
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Entity Type | Individual
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Provider Name | LIAM VINCENT HERREBOUT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD DEPT 119
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-668-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 LAKEHURST DR APT 203
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City | WAUKEGAN
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State | IL
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Zip | 60085-8249
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Country | US
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Telephone | 708-691-3621
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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 | 051.306891
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License Number State | IL
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