Individual
DR. GORDON LEAV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3201 N BROADWAY ST, CHICAGO, IL 60657-3514
(773) 327-3591
Mailing address
3201 N BROADWAY ST, CHICAGO, IL 60657-3514
(773) 327-3591
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051292629
IL
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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