Provider Demographics
NPI:1437286333
Name:IDLEMAN, LANCE ORBIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ORBIN
Last Name:IDLEMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SIMPSON STATION DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40067-5410
Mailing Address - Country:US
Mailing Address - Phone:502-314-9038
Mailing Address - Fax:
Practice Address - Street 1:1620 EASTPOINT PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4123
Practice Address - Country:US
Practice Address - Phone:502-245-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11491183500000X
OK12192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist