Provider Demographics
NPI:1922112580
Name:COMMONS, THEODORE JOSEPH (RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:COMMONS
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:47991-8089
Mailing Address - Country:US
Mailing Address - Phone:217-554-5581
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26091727A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist