MEDICARE: EISELE'S CASEYVILLE PHARM

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
1	333600000X	Pharmacy	54-7377	IL

General Provider Information

NPI Number	:	1912985060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EISELE'S CASEYVILLE PHARM

Provider Business Mailing Address
First Line	:	PO BOX 335
Second Line	:
City	:	CASEYVILLE
State	:	IL
Zip	:	62232-0335
Country	:	US
Telephone Number	:	618-345-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W LINCOLN AVE
Second Line	:
City	:	CASEYVILLE
State	:	IL
Zip	:	62232-1438
Country	:	US
Telephone Number	:	618-345-9702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES V EISELE
Credential	:	RPH
Telephone Number	:	618-345-0188

Provider Enumeration Date	:	01/07/2006
Last Update Date	:	01/11/2013

Similar Medicare Providers

1750325577 — JAMES V EISELE RPH
Practice Location Address:

200 W LINCOLN AVE
CASEYVILLE, IL
62232-1438

Practice Phone: 618-345-0188
Practice Fax: 618-345-2452

1215922000 — DR. MARK EDWARD MCGRANAHAN M.D.
Practice Location Address:

1230 GEORGE E. CHANCE PARKWAY
CASEYVILLE, IL
62232

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Practice Fax:

1700850526 — CASEYVILLE NURSING & REHABILITATION CENTER INC.
Practice Location Address:

601 W LINCOLN AVE
CASEYVILLE, IL
62232-1306

Practice Phone: 618-345-3072
Practice Fax: 618-345-3170

1699884825 — DR. LORI LEE EBERHART M.D.
Practice Location Address:

1230 GEORGE E. CHANCE PARKWAY
CASEYVILLE, IL
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Practice Phone: 618-345-5437
Practice Fax: 618-344-9246

1902909153 — DR. JEAN EVELYN VOGEL WAGNER M.D.
Practice Location Address:

1230 GEORGE E CHANCE PARKWAY
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1598930240 — CASEYVILLE NURSING & REHABILITATION CENTER INC.
Practice Location Address:

601 W LINCOLN AVE
CASEYVILLE, IL
62232-1306

Practice Phone: 847-982-2300
Practice Fax: 847-982-2304

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