Healthcare Provider Details

I. General information

NPI: 1609140177
Provider Name (Legal Business Name): MS. DARLA L DEWIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7846 AVIATION DR
MARION IL
62959-5818
US

IV. Provider business mailing address

7846 AVIATION DR
MARION IL
62959-5818
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-9200
  • Fax: 618-998-1485
Mailing address:
  • Phone: 618-993-9200
  • Fax: 618-998-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.040959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: