Healthcare Provider Details

I. General information

NPI: 1689261141
Provider Name (Legal Business Name): KRYSTAL SCHOENHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W MAIN ST
LENA IL
61048-9247
US

IV. Provider business mailing address

154 W MAIN ST
LENA IL
61048-9247
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 Number051295416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: