MEDICARE: DR. JONATHON HEILBRONN PHARMD

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
1	183500000X	Pharmacist	051.296975	IL

General Provider Information

NPI Number	:	1518359033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHON HEILBRONN PHARMD

Provider Business Mailing Address
First Line	:	191 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6232
Country	:	US
Telephone Number	:	312-634-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6232
Country	:	US
Telephone Number	:	312-634-0152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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