Healthcare Provider Details

I. General information

NPI: 1750496782
Provider Name (Legal Business Name): LADONNA POEHLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W JOURDAN ST
NEWTON IL
62448-1056
US

IV. Provider business mailing address

4768 ATHENS LN
LOUISVILLE IL
62858-2436
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-2838
  • Fax: 618-783-3978
Mailing address:
  • Phone: 618-783-2838
  • Fax: 618-783-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054018183
License Number StateIL

VIII. Authorized Official

Name: MRS. LADONNA K POEHLER
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 618-783-2838