Provider Demographics
NPI:1881965358
Name:LOCKRIDGE, ANTHONY (PHARMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LOCKRIDGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1762
Mailing Address - Country:US
Mailing Address - Phone:708-283-1147
Mailing Address - Fax:773-731-4761
Practice Address - Street 1:645 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1762
Practice Address - Country:US
Practice Address - Phone:708-283-1147
Practice Address - Fax:773-731-4761
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist