Provider Demographics
NPI:1871646299
Name:UKLEJA, THEODORE E (RPH)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:E
Last Name:UKLEJA
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 1:10423 N NORTH FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1306
Mailing Address - Country:US
Mailing Address - Phone:309-691-0920
Mailing Address - Fax:
Practice Address - Street 1:6820 N PEARTREE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2471
Practice Address - Country:US
Practice Address - Phone:309-689-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist