Healthcare Provider Details

I. General information

NPI: 1578677167
Provider Name (Legal Business Name): PATRICK GEORGE SCHLEICH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W. MAIN ST.
LENA IL
61048-0666
US

IV. Provider business mailing address

PO BOX 666
LENA IL
61048-0666
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 TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054007023
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054-007023
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-028405
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: