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NPI Code Detail

MEDICARE: MR. JAMES A DETERS RPH

MEDICARE: MR. JAMES A DETERS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03318237OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103318237OTHEROHPHARMACY LICENSE #

General Provider Information

NPI Number : 1710260948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES A DETERS RPH
Provider Business Mailing Address
First Line : 701 N CABLE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-1737
Country : US
Telephone Number : 419-222-9462
Fax Number : 419-222-8345
Provider Business Practice Location Address
First Line : 701 N CABLE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-1737
Country : US
Telephone Number : 419-222-9462
Fax Number : 419-222-8345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2011
Last Update Date : 09/23/2011

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