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General NPI Number Information
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NPI Number | 1336677681
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Entity Type | Individual
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Provider Name | JOHN DALE POWLESS RPH
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 121 W NORTH AVE
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City | FLORA
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State | IL
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Zip | 62839-1613
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Country | US
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Telephone | 618-662-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 4898 N IL 130
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City | OLNEY
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State | IL
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Zip | 62450-3738
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Country | US
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Telephone |
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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 | 051-036868
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License Number State | IL
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