Healthcare Provider Details

I. General information

NPI: 1154608511
Provider Name (Legal Business Name): DONALD HUTTON II RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2011
Last Update Date: 11/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S LOGAN AVE
MATTOON IL
61938-4595
US

IV. Provider business mailing address

212 S LOGAN AVE
MATTOON IL
61938-4595
US

V. Phone/Fax

Practice location:
  • Phone: 217-235-3126
  • Fax: 217-234-3675
Mailing address:
  • Phone: 217-235-3126
  • Fax: 217-234-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-033776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: