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General NPI Number Information
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NPI Number | 1194361048
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Entity Type | Individual
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Provider Name | JOHN MARTIN CARMODY
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Gender | Male
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 1 TROY SQ
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City | TROY
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State | MO
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Zip | 63379-3101
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Country | US
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Telephone | 636-528-8667
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Fax | 636-462-7010
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Provider Business Mailing Address
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Address Line | 2 NICHOLAS CT
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City | WHITE HEATH
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State | IL
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Zip | 61884-9342
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Country | US
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Telephone | 309-371-7862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051029319
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License Number State | IL
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