Provider Demographics
NPI:1518162593
Name:LINDBLOOM, ROBERT E (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:LINDBLOOM
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 1:11665 195TH ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1203
Mailing Address - Country:US
Mailing Address - Phone:708-479-7338
Mailing Address - Fax:
Practice Address - Street 1:17930 WOLF RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5492
Practice Address - Country:US
Practice Address - Phone:708-479-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist