Healthcare Provider Details

I. General information

NPI: 1851841159
Provider Name (Legal Business Name): RHONDA LENKAITIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 IL HWY 1
CARMI IL
62821
US

IV. Provider business mailing address

1344 IL HWY 1
CARMI IL
62821
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-5838
  • Fax:
Mailing address:
  • Phone: 618-382-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051286691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: