Provider Demographics
NPI:1669843546
Name:GOULD, HENRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:GOULD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9336 LATROBE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1132
Mailing Address - Country:US
Mailing Address - Phone:847-966-6894
Mailing Address - Fax:847-966-6894
Practice Address - Street 1:9336 LATROBE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1132
Practice Address - Country:US
Practice Address - Phone:847-966-6894
Practice Address - Fax:847-966-6894
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-023030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist