Healthcare Provider Details

I. General information

NPI: 1134091119
Provider Name (Legal Business Name): MICHELE HENTCHEU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PLAZA DR
ANNA IL
62906-2034
US

IV. Provider business mailing address

1207 S WALL ST
CARBONDALE IL
62901-3793
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4521
  • Fax: 618-833-4531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051304649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: