Healthcare Provider Details

I. General information

NPI: 1306970769
Provider Name (Legal Business Name): GARY LAWRENCE BREECE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MAIN ST
WHITE HALL IL
62092-1054
US

IV. Provider business mailing address

1000 N MAIN ST
WHITE HALL IL
62092-1186
US

V. Phone/Fax

Practice location:
  • Phone: 217-374-6712
  • Fax:
Mailing address:
  • Phone: 217-374-2988
  • Fax:

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: