Healthcare Provider Details

I. General information

NPI: 1821149766
Provider Name (Legal Business Name): THE FOUR L'S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 S BUCHANAN ST
EDWARDSVILLE IL
62025-2064
US

IV. Provider business mailing address

447 S BUCHANAN ST
EDWARDSVILLE IL
62025-2064
US

V. Phone/Fax

Practice location:
  • Phone: 618-692-4441
  • Fax: 618-692-4415
Mailing address:
  • Phone: 618-692-4441
  • Fax: 618-692-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. VICKI L THALMANN
Title or Position: OWNER
Credential: RN
Phone: 618-692-4441