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Individual

DALE SUHRENBROCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
1122 VAUGHN RD, WOOD RIVER, IL 62095-1848
(618) 259-2013
(618) 259-2098
Mailing address
805 CHANCELLOR DR, EDWARDSVILLE, IL 62025-3936
(618) 830-0668

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
029774
MO
183500000X
Pharmacist
Primary
051.031813
IL

Other

Enumeration date
09/20/2011
Last updated
09/20/2011
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