Provider Demographics
NPI:1487931952
Name:LEVI, CORNETTA R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CORNETTA
Middle Name:R
Last Name:LEVI
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 1:4357 S INDIANA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4717
Mailing Address - Country:US
Mailing Address - Phone:515-710-3449
Mailing Address - Fax:
Practice Address - Street 1:4357 S INDIANA AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4717
Practice Address - Country:US
Practice Address - Phone:515-710-3449
Practice Address - Fax:773-855-2035
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist