Healthcare Provider Details

I. General information

NPI: 1235014945
Provider Name (Legal Business Name): PAUL WCAHTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W MAIN ST
LENA IL
61048-9247
US

IV. Provider business mailing address

PO BOX 434
LENA IL
61048-0434
US

V. Phone/Fax

Practice location:
  • Phone: 815-369-4111
  • Fax: 815-369-2602
Mailing address:
  • Phone: 815-369-4111
  • Fax: 815-369-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051036809
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: