Healthcare Provider Details

I. General information

NPI: 1437286333
Provider Name (Legal Business Name): LANCE ORBIN IDLEMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 EASTPOINT PKWY
LOUISVILLE KY
40223-4123
US

IV. Provider business mailing address

107 SIMPSON STATION DR
SIMPSONVILLE KY
40067-5410
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-4239
  • Fax:
Mailing address:
  • Phone: 502-314-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11491
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12192
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: