Healthcare Provider Details

I. General information

NPI: 1083983076
Provider Name (Legal Business Name): JAMES DENTON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S. COURT STREET
CROWN POINT IN
46307
US

IV. Provider business mailing address

1520 S COURT ST
CROWN POINT IN
46307-4809
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-0336
  • Fax: 219-663-8647
Mailing address:
  • Phone: 219-663-0336
  • Fax: 219-663-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016794A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: