Provider Demographics
NPI:1902167828
Name:SCHUBERT-HENSS, NANCY LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:SCHUBERT-HENSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 SUNNYSIDE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-1922
Mailing Address - Country:US
Mailing Address - Phone:618-977-1577
Mailing Address - Fax:618-224-7710
Practice Address - Street 1:405 E BROADWAY
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-1663
Practice Address - Country:US
Practice Address - Phone:618-224-7316
Practice Address - Fax:618-224-7710
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist