Healthcare Provider Details

I. General information

NPI: 1053790055
Provider Name (Legal Business Name): TODD LEHMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST SUITE A
TUSCOLA IL
61953-1419
US

IV. Provider business mailing address

101 N MAIN ST SUITE A
TUSCOLA IL
61953-1419
US

V. Phone/Fax

Practice location:
  • Phone: 217-454-8191
  • Fax: 217-253-3238
Mailing address:
  • Phone: 217-454-8191
  • Fax: 217-253-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051035841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: