Healthcare Provider Details

I. General information

NPI: 1750168167
Provider Name (Legal Business Name): DEBORAH LYNNE LINDQUIST PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 N ILLINOIS ST
FAIRVIEW HEIGHTS IL
62208-2001
US

IV. Provider business mailing address

1680 SHADOW RIDGE CT APT 5
BELLEVILLE IL
62221-3904
US

V. Phone/Fax

Practice location:
  • Phone: 618-394-8744
  • Fax:
Mailing address:
  • Phone: 217-671-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: