Healthcare Provider Details

I. General information

NPI: 1407332471
Provider Name (Legal Business Name): LYNSEY A VAHLE-PIEPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 GODFREY RD
GODFREY IL
62035-3311
US

IV. Provider business mailing address

2712 GODFREY RD
GODFREY IL
62035-3311
US

V. Phone/Fax

Practice location:
  • Phone: 618-466-0825
  • Fax: 618-467-0544
Mailing address:
  • Phone: 618-466-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.297554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: