Healthcare Provider Details

I. General information

NPI: 1750325577
Provider Name (Legal Business Name): JAMES V EISELE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LINCOLN AVE
CASEYVILLE IL
62232-1438
US

IV. Provider business mailing address

255 JULIA PL
BELLEVILLE IL
62223-1218
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-0188
  • Fax: 618-345-2452
Mailing address:
  • Phone: 618-398-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040348
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: