Provider Demographics
NPI:1679176150
Name:TRAEGER, MEGAN LEANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEANNE
Last Name:TRAEGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SILVER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9401
Mailing Address - Country:US
Mailing Address - Phone:217-721-7986
Mailing Address - Fax:
Practice Address - Street 1:137 W FRONT ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:IL
Practice Address - Zip Code:61738-1555
Practice Address - Country:US
Practice Address - Phone:309-527-3627
Practice Address - Fax:309-527-3630
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist