Provider Demographics
NPI:1770866105
Name:LEVANGE, RALPH LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LEE
Last Name:LEVANGE
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 1:23 S RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8335
Mailing Address - Country:US
Mailing Address - Phone:815-304-4293
Mailing Address - Fax:
Practice Address - Street 1:1050 N KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2033
Practice Address - Country:US
Practice Address - Phone:815-932-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-030040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist