Healthcare Provider Details

I. General information

NPI: 1679989503
Provider Name (Legal Business Name): HARRY MICHAEL ZOLLARS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N CENTER ST
MARYVILLE IL
62062-5624
US

IV. Provider business mailing address

PO BOX 160
MARYVILLE IL
62062-0160
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-7474
  • Fax: 618-288-1860
Mailing address:
  • Phone: 618-288-7474
  • Fax: 618-288-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013032796
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: