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General NPI Number Information
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NPI Number | 1346875127
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Entity Type | Organization
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Legal Business Name | THIES-LOMBARD PHARMACY, INC
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 211 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-2678
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Country | US
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Telephone | 630-495-2333
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Fax | 630-495-2355
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Provider Business Mailing Address
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Address Line | 211 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-2678
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Country | US
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Telephone | 630-495-2333
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Fax | 630-495-2355
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLARKE ALLAN KUELTZO
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Credential |
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Telephone | 630-495-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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