Provider Demographics
NPI:1851755326
Name:LETITRIDE INC
Entity Type:Organization
Organization Name:LETITRIDE INC
Other - Org Name:CHENOA RX LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVEGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-945-4211
Mailing Address - Street 1:209 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHENOA
Mailing Address - State:IL
Mailing Address - Zip Code:61726-1133
Mailing Address - Country:US
Mailing Address - Phone:815-945-4211
Mailing Address - Fax:815-945-7466
Practice Address - Street 1:209 S GREEN ST
Practice Address - Street 2:
Practice Address - City:CHENOA
Practice Address - State:IL
Practice Address - Zip Code:61726-1133
Practice Address - Country:US
Practice Address - Phone:815-945-4211
Practice Address - Fax:815-945-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0194873336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159288OtherPK
2159288OtherPK
IL7553790001Medicare NSC