1942595772 NPI number — MEGAN ELIZABETH FLEISCHMAN PHARMD

Table of content: MEGAN ELIZABETH FLEISCHMAN PHARMD (NPI 1942595772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942595772 NPI number — MEGAN ELIZABETH FLEISCHMAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEISCHMAN
Provider First Name:
MEGAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KULTGEN
Provider Other First Name:
MEGAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942595772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 PARKVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61107-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-395-5761
Provider Business Mailing Address Fax Number:
815-395-5935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 E STATE ST
Provider Second Line Business Practice Location Address:
ATTN: CLINICAL PHARMACIST
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61104-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-395-5761
Provider Business Practice Location Address Fax Number:
815-395-5935
Provider Enumeration Date:
06/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  015-296995 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PH60163703 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)