Provider Demographics
NPI:1487678934
Name:MONROE, RICHARD L (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:MONROE
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 1:418 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1247
Mailing Address - Country:US
Mailing Address - Phone:309-263-4512
Mailing Address - Fax:
Practice Address - Street 1:925 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5129
Practice Address - Country:US
Practice Address - Phone:309-676-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist