Healthcare Provider Details

I. General information

NPI: 1619128287
Provider Name (Legal Business Name): BEN J CALCATERRA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RUSHING DR
HERRIN IL
62948-3730
US

IV. Provider business mailing address

401 RUSHING DR
HERRIN IL
62948-3730
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-9997
  • Fax: 618-997-2747
Mailing address:
  • Phone: 618-997-9997
  • Fax: 618-997-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051289227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: