Provider Demographics
NPI:1811613508
Name:LINGENFELTER, THEODORE J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:LINGENFELTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51618 MEADOW POINTE
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5125
Mailing Address - Country:US
Mailing Address - Phone:574-326-9884
Mailing Address - Fax:
Practice Address - Street 1:3610 BREMEN HWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-6500
Practice Address - Country:US
Practice Address - Phone:574-254-2510
Practice Address - Fax:574-254-2565
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029859A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy