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NPI Code Detail

MEDICARE: PATRICK SCHLEICH

MEDICARE: PATRICK SCHLEICH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacyIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11424100OTHERILNCPDP

General Provider Information

NPI Number : 1922280346
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATRICK SCHLEICH
Provider Business Mailing Address
First Line : PO BOX 666
Second Line :
City : LENA
State : IL
Zip : 61048-0666
Country : US
Telephone Number : 815-369-4111
Fax Number :
Provider Business Practice Location Address
First Line : 154 W MAIN ST
Second Line :
City : LENA
State : IL
Zip : 61048-9247
Country : US
Telephone Number : 815-369-4111
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. PATRICK GEORGE SCHLEICH
Credential : R.PH.
Telephone Number : 815-369-4111
Provider Enumeration Date : 11/27/2007
Last Update Date : 04/20/2008

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