Jan E Fehrenbacher

Individual provider Active NPI Pharmacist · Lincoln, IL

NPI 1104100114 · NPPES record last updated Oct 10, 2011

Key facts

NPI
1104100114
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
051-041193 (IL)
Practice address
603 Woodlawn
Lincoln, IL 62656
Phone
(217) 732-1825
Fax
(217) 732-7796
NPI assigned
Oct 10, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
051-041193ILMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051-041193 IL Yes

Addresses

Primary practice location

603 Woodlawn
Lincoln, IL 62656

Mailing address

603 Woodlawn
Lincoln, IL 62656
Phone (217) 732-1825

Other providers in Lincoln, IL

All providers in Lincoln, IL · Pharmacist in Illinois

Sources for this page

Verify at the official NPI Registry.