Provider Demographics
NPI:1679565790
Name:LOCKARD, MARK LEN (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEN
Last Name:LOCKARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8739 N 1550 BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-4367
Mailing Address - Country:US
Mailing Address - Phone:618-943-7206
Mailing Address - Fax:618-943-7233
Practice Address - Street 1:8739 N 1550 BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-4367
Practice Address - Country:US
Practice Address - Phone:618-943-7206
Practice Address - Fax:618-943-7233
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist