Provider Demographics
NPI:1528664323
Name:MANTHE, RHONDA S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:S
Last Name:MANTHE
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 1:444 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2866
Mailing Address - Country:US
Mailing Address - Phone:309-853-3562
Mailing Address - Fax:
Practice Address - Street 1:444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2866
Practice Address - Country:US
Practice Address - Phone:309-853-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-286212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist