Provider Demographics
NPI:1932698735
Name:CLIMACO HERSCHBERGER, DOLORES
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:CLIMACO HERSCHBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911-1334
Mailing Address - Country:US
Mailing Address - Phone:217-543-2913
Mailing Address - Fax:217-543-2943
Practice Address - Street 1:118 S VINE ST
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1334
Practice Address - Country:US
Practice Address - Phone:217-543-2913
Practice Address - Fax:217-543-2943
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist