Healthcare Provider Details

I. General information

NPI: 1437243136
Provider Name (Legal Business Name): ELIZABETH ANNE DINGES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ILLINI RD
SPRINGFIELD IL
62704
US

IV. Provider business mailing address

2121 ILLINI RD
SPRINGFIELD IL
62704-4365
US

V. Phone/Fax

Practice location:
  • Phone: 520-820-7712
  • Fax:
Mailing address:
  • Phone: 520-820-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051297457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: