Provider Demographics
NPI:1407332471
Name:VAHLE-PIEPER, LYNSEY A
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:A
Last Name:VAHLE-PIEPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-3311
Mailing Address - Country:US
Mailing Address - Phone:618-466-0825
Mailing Address - Fax:
Practice Address - Street 1:2712 GODFREY RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-3311
Practice Address - Country:US
Practice Address - Phone:618-466-0825
Practice Address - Fax:618-467-0544
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist