Healthcare Provider Details

I. General information

NPI: 1922280346
Provider Name (Legal Business Name): PATRICK SCHLEICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 04/20/2008
Certification Date:
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 666
LENA IL
61048-0666
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. PATRICK GEORGE SCHLEICH
Title or Position: OWNER
Credential: R.PH.
Phone: 815-369-4111