Organization
THIES-LOMBARD PHARMACY, INC
Active
Other names
Lombard Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARKE ALLAN KUELTZO PHARMD (PRESIDENT)
(630) 495-2333
Entity
Organization
Contact information
Practice address
211 S MAIN ST, LOMBARD, IL 60148-2678
(630) 495-2333
(630) 495-2355
Mailing address
211 S MAIN ST, LOMBARD, IL 60148-2678
(630) 495-2333
(630) 495-2355
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
54-4487
IL
333600000X
Pharmacy
Primary
54-4487
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1408574
NCPDP PROVIDER ID
IL
Enumeration date
10/27/2005
Last updated
03/07/2023
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