Provider Demographics
NPI:1033725346
Name:GOULD, KACEE JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KACEE
Middle Name:JO
Last Name:GOULD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KACEE
Other - Middle Name:JO
Other - Last Name:VERHOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5758 S MARYLAND AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5758 S MARYLAND AVE STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-834-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015514183500000X
MO2019025953183500000X
IL051303375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist