Provider Demographics
NPI:1194028498
Name:LECHTENBERG, DORA JEAN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:DORA
Middle Name:JEAN
Last Name:LECHTENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1732
Mailing Address - Country:US
Mailing Address - Phone:208-888-4414
Mailing Address - Fax:208-884-3170
Practice Address - Street 1:20 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1732
Practice Address - Country:US
Practice Address - Phone:208-888-4414
Practice Address - Fax:208-884-3170
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist