Healthcare Provider Details

I. General information

NPI: 1184227019
Provider Name (Legal Business Name): MR. DAVID LEE EYNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 E MAIN ST
SPRINGFIELD OH
45503-4915
US

IV. Provider business mailing address

2565 E MAIN ST
SPRINGFIELD OH
45503-4915
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-6473
  • Fax: 937-525-9789
Mailing address:
  • Phone: 937-323-6473
  • Fax: 937-525-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03118975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: