Healthcare Provider Details

I. General information

NPI: 1932698735
Provider Name (Legal Business Name): DOLORES CLIMACO HERSCHBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S VINE ST
ARTHUR IL
61911-1334
US

IV. Provider business mailing address

118 S VINE ST
ARTHUR IL
61911-1334
US

V. Phone/Fax

Practice location:
  • Phone: 217-543-2913
  • Fax: 217-543-2943
Mailing address:
  • Phone: 217-543-2913
  • Fax: 217-543-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051297611
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: