Healthcare Provider Details

I. General information

NPI: 1487875472
Provider Name (Legal Business Name): BARBARA LEA STOECKLIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7846 AVIATION DR
MARION IL
62959-5818
US

IV. Provider business mailing address

2203 BRENTWOOD DR
MARION IL
62959-1496
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-2900
  • Fax:
Mailing address:
  • Phone: 618-993-2900
  • Fax: 618-998-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: