MEDICARE: DR. MARI G LEAHY 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	11829201	IL

General Provider Information

NPI Number	:	1700880077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARI G LEAHY PHARMD

Provider Business Mailing Address
First Line	:	2600 N SOUTHPORT AVE
Second Line	:	APT 215
City	:	CHICAGO
State	:	IL
Zip	:	60614-1135
Country	:	US
Telephone Number	:	773-244-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 N CHILDRENS PLZ
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3363
Country	:	US
Telephone Number	:	773-880-4545
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	09/11/2025

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