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NPI Code Detail

MEDICARE: LEO SIMON WEBER RPH

MEDICARE: LEO SIMON WEBER RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051032123IL

General Provider Information

NPI Number : 1144505470
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEO SIMON WEBER RPH
Provider Business Mailing Address
First Line : 2345 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2423
Country : US
Telephone Number : 773-429-0767
Fax Number : 773-239-4569
Provider Business Practice Location Address
First Line : 2345 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2423
Country : US
Telephone Number : 773-429-0767
Fax Number : 773-239-4569
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 10/18/2011

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