Provider Demographics
NPI:1427338961
Name:LEUNG, MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8653 HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2209
Mailing Address - Country:US
Mailing Address - Phone:773-764-0050
Mailing Address - Fax:773-764-9854
Practice Address - Street 1:6140 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2816
Practice Address - Country:US
Practice Address - Phone:773-764-0050
Practice Address - Fax:773-764-9854
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist