Healthcare Provider Details

I. General information

NPI: 1407130792
Provider Name (Legal Business Name): DAVID WARREN WRIGHT PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 HIGHWAY 14 WEST
CHRISTOPHER IL
62822
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-2436
  • Fax: 618-724-2571
Mailing address:
  • Phone: 618-724-2436
  • Fax: 618-724-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051028893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: