Healthcare Provider Details

I. General information

NPI: 1982203006
Provider Name (Legal Business Name): CHRISTOPHER HURTTE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WESLEY DR
WOOD RIVER IL
62095-1894
US

IV. Provider business mailing address

721 HILLSBORO AVE
EDWARDSVILLE IL
62025-1820
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-0293
  • Fax:
Mailing address:
  • Phone: 618-406-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051288344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: