Healthcare Provider Details

I. General information

NPI: 1609851260
Provider Name (Legal Business Name): JAMES BALLEW MAPLE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E PLEASANT ST
TAYLORVILLE IL
62568-1562
US

IV. Provider business mailing address

2210 NORTHSHIRE RD
TAYLORVILLE IL
62568-9769
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-1668
  • Fax: 217-824-1671
Mailing address:
  • Phone: 217-824-1668
  • Fax: 217-824-1671

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: