Provider Demographics
NPI:1154757706
Name:LEAV, DANIELLE PAZ
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PAZ
Last Name:LEAV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9224
Mailing Address - Country:US
Mailing Address - Phone:773-348-3574
Mailing Address - Fax:
Practice Address - Street 1:1200 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8341
Practice Address - Country:US
Practice Address - Phone:312-943-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist