Provider Demographics
NPI:1649743626
Name:LEBEAU, PHOEBE SEBHATU (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:SEBHATU
Last Name:LEBEAU
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 1:3133 N CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6818
Mailing Address - Country:US
Mailing Address - Phone:319-331-3004
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3832
Practice Address - Country:US
Practice Address - Phone:312-942-9485
Practice Address - Fax:312-942-3455
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512959271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist