MEDICARE: DR. BRITTNEY LEIGH KONRAD 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	051.293696	IL

General Provider Information

NPI Number	:	1821692427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRITTNEY LEIGH KONRAD PHARMD

Provider Business Mailing Address
First Line	:	208 W WASHINGTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-3558
Country	:	US
Telephone Number	:	312-201-5921
Fax Number	:	312-201-5926

Provider Business Practice Location Address
First Line	:	208 W WASHINGTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-3558
Country	:	US
Telephone Number	:	312-201-5921
Fax Number	:	312-201-5926

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

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	11/24/2020

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