=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679655468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L DOYLE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 08/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 E STATE ST
-----------------------------------------------------
City | SYCAMORE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60178-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-895-2444
-----------------------------------------------------
Fax | 815-895-6782
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 403 E STATE ST
-----------------------------------------------------
City | SYCAMORE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60178-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHCST
-----------------------------------------------------
Name | THOMAS OSHEA
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 815-895-2444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 054014017
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------