Healthcare Provider Details

I. General information

NPI: 1215044920
Provider Name (Legal Business Name): JAMES PAUL VERTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MACOUPIN DIPPOLD DRUG CO INC
GILLESPIE IL
62033
US

IV. Provider business mailing address

709 WESTERN
GILLESPIE IL
62033
US

V. Phone/Fax

Practice location:
  • Phone: 217-839-9901
  • Fax:
Mailing address:
  • Phone: 217-839-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: