Provider Demographics
NPI:1346875127
Name:THIES-LOMBARD PHARMACY, INC
Entity Type:Organization
Organization Name:THIES-LOMBARD PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KUELTZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-495-2333
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2678
Mailing Address - Country:US
Mailing Address - Phone:630-495-2333
Mailing Address - Fax:630-495-2355
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2678
Practice Address - Country:US
Practice Address - Phone:630-495-2333
Practice Address - Fax:630-495-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy