Provider Demographics
NPI:1164021614
Name:GRYZ, LEANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:
Last Name:GRYZ
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 1:11111 S KEAN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-3106
Mailing Address - Country:US
Mailing Address - Phone:708-897-4102
Mailing Address - Fax:
Practice Address - Street 1:5501 S HALSTED ST STE 147
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2229
Practice Address - Country:US
Practice Address - Phone:773-359-8570
Practice Address - Fax:773-359-8571
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist