Provider Demographics
NPI:1902187990
Name:HAILE, GUENET (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GUENET
Middle Name:
Last Name:HAILE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2202
Mailing Address - Country:US
Mailing Address - Phone:630-783-3916
Mailing Address - Fax:630-783-8472
Practice Address - Street 1:680 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2202
Practice Address - Country:US
Practice Address - Phone:630-783-3916
Practice Address - Fax:630-783-8472
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist