Provider Demographics
NPI:1750496782
Name:LADONNA POEHLER LLC
Entity Type:Organization
Organization Name:LADONNA POEHLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:POEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-783-2838
Mailing Address - Street 1:4768 ATHENS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62858-2436
Mailing Address - Country:US
Mailing Address - Phone:618-783-2838
Mailing Address - Fax:618-783-3978
Practice Address - Street 1:600 W JOURDAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1056
Practice Address - Country:US
Practice Address - Phone:618-783-2838
Practice Address - Fax:618-783-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540181833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1465182OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IL371330596001Medicaid
ILIL1302OtherCMS 855 PTAN
ILIL1302OtherCMS 855 PTAN
IL371330596001Medicaid