Healthcare Provider Details

I. General information

NPI: 1760474332
Provider Name (Legal Business Name): SCOTT MICHAEL DRABANT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 BROADWAY ST
RICHMOND IL
60071-9534
US

IV. Provider business mailing address

5805 BROADWAY ST
RICHMOND IL
60071-9534
US

V. Phone/Fax

Practice location:
  • Phone: 815-678-4577
  • Fax: 815-759-8090
Mailing address:
  • Phone: 815-678-4577
  • Fax: 815-759-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: