Provider Demographics
NPI:1952161028
Name:THALMANN, TED SAMUEL (RPH)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:SAMUEL
Last Name:THALMANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GASLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1497
Mailing Address - Country:US
Mailing Address - Phone:618-979-2613
Mailing Address - Fax:
Practice Address - Street 1:506 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1561
Practice Address - Country:US
Practice Address - Phone:618-635-2538
Practice Address - Fax:618-623-0991
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist