Provider Demographics
NPI:1578677167
Name:SCHLEICH, PATRICK GEORGE (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GEORGE
Last Name:SCHLEICH
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:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-0666
Mailing Address - Country:US
Mailing Address - Phone:815-369-4111
Mailing Address - Fax:815-369-2602
Practice Address - Street 1:154 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-0666
Practice Address - Country:US
Practice Address - Phone:815-369-4111
Practice Address - Fax:815-369-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540070233336C0003X
IL054-0070233336L0003X
IL051-028405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1424100OtherNCPDP
IL363059337001Medicaid
IL0187660001Medicare NSC