Provider Demographics
NPI:1134400617
Name:UPHUES, LYNLEE INGRID (RPH)
Entity type:Individual
Prefix:
First Name:LYNLEE
Middle Name:INGRID
Last Name:UPHUES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2531
Mailing Address - Country:US
Mailing Address - Phone:708-863-1010
Mailing Address - Fax:708-863-4961
Practice Address - Street 1:4800 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2531
Practice Address - Country:US
Practice Address - Phone:708-863-1010
Practice Address - Fax:708-863-4961
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist