Provider Demographics
NPI:1215221551
Name:GOULD, ROBERT JAY
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAY
Last Name:GOULD
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:JAY
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1216 HIGHLAND LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2551
Mailing Address - Country:US
Mailing Address - Phone:847-420-5226
Mailing Address - Fax:
Practice Address - Street 1:2241 WILLOW RD
Practice Address - Street 2:T-1167
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7636
Practice Address - Country:US
Practice Address - Phone:847-657-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.028092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist