Provider Demographics
NPI:1164574034
Name:LETZKUS, PAMELA LYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LYN
Last Name:LETZKUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745-9325
Mailing Address - Country:US
Mailing Address - Phone:217-935-9571
Mailing Address - Fax:217-937-5250
Practice Address - Street 1:422 W WHITE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2272
Practice Address - Country:US
Practice Address - Phone:217-935-9571
Practice Address - Fax:217-937-5250
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist