=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740309251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEHMAN'S PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 11/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 N MAIN ST
-----------------------------------------------------
City | TUSCOLA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61953-1490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-253-4746
-----------------------------------------------------
Fax | 217-253-3238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 N MAIN ST
-----------------------------------------------------
City | TUSCOLA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61953-1490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-253-4746
-----------------------------------------------------
Fax | 217-253-3238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TODD WILLIAM LEHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-253-4746
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 054007317
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 054016763
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------