Provider Demographics
NPI:1730780214
Name:HERRMANN, RHONDA LEIGH (RPH)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEIGH
Last Name:HERRMANN
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 1:710 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2346
Mailing Address - Country:US
Mailing Address - Phone:618-252-3059
Mailing Address - Fax:618-252-3252
Practice Address - Street 1:13969 MOORE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6835
Practice Address - Country:US
Practice Address - Phone:618-751-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037099183500000X
IL051-037099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist