Healthcare Provider Details

I. General information

NPI: 1689958167
Provider Name (Legal Business Name): THOMAS LEE EDMONS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22257 W HONEY RIDGE CT
KILDEER IL
60047-3302
US

IV. Provider business mailing address

22257 W HONEY RIDGE CT
KILDEER IL
60047-3302
US

V. Phone/Fax

Practice location:
  • Phone: 847-800-8043
  • Fax: 847-847-7936
Mailing address:
  • Phone: 847-800-8043
  • Fax: 847-847-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number05132040
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: