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NPI Code Detail

MEDICARE: HENRY T LUCHTEFELD RPH

MEDICARE: HENRY T LUCHTEFELD RPH
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
1183500000XPharmacist051036231IL

General Provider Information

NPI Number : 1992713721
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY T LUCHTEFELD RPH
Provider Business Mailing Address
First Line : 1013 E MONROE ST
Second Line :
City : MORTON
State : IL
Zip : 61550-2318
Country : US
Telephone Number : 309-589-6800
Fax Number :
Provider Business Practice Location Address
First Line : 7717 N ORANGE PRAIRIE RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-9323
Country : US
Telephone Number : 309-589-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 02/25/2016

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