Provider Demographics
NPI:1548436256
Name:FELDMAN, MICHAEL LESLIE (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LESLIE
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 ROLLINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3957
Mailing Address - Country:US
Mailing Address - Phone:847-433-1093
Mailing Address - Fax:
Practice Address - Street 1:5TH & ROOSEVELT RD BUILDING 37 NW
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-028745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist