Provider Demographics
NPI:1821149766
Name:THE FOUR L'S INC
Entity Type:Organization
Organization Name:THE FOUR L'S INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:THALMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-692-4441
Mailing Address - Street 1:447 S BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2064
Mailing Address - Country:US
Mailing Address - Phone:618-692-4441
Mailing Address - Fax:618-692-4415
Practice Address - Street 1:447 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2064
Practice Address - Country:US
Practice Address - Phone:618-692-4441
Practice Address - Fax:618-692-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467201OtherNCPDP #
ILBT7614856OtherDEA #
IL=========001Medicaid
IL=========001Medicaid