Provider Demographics
NPI:1609586049
Name:POEPLAU, JOACHIM (RPH)
Entity Type:Individual
Prefix:
First Name:JOACHIM
Middle Name:
Last Name:POEPLAU
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 1:1911 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2148
Mailing Address - Country:US
Mailing Address - Phone:618-943-6386
Mailing Address - Fax:
Practice Address - Street 1:1 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-1719
Practice Address - Country:US
Practice Address - Phone:618-253-8182
Practice Address - Fax:618-253-6101
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-029232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist