Healthcare Provider Details

I. General information

NPI: 1558641282
Provider Name (Legal Business Name): BILLY J MCCALLISTER PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JOHN DEERE RD
MOLINE IL
61265-6892
US

IV. Provider business mailing address

500 JOHN DEERE RD
MOLINE IL
61265-6892
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-5010
  • Fax: 309-779-5018
Mailing address:
  • Phone: 309-779-5010
  • Fax: 309-779-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20436
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: