=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447533021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON ESHELMAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 W PIKE ST
-----------------------------------------------------
City | GOSHEN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46526-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-534-7616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26469 COUNTY ROAD 54
-----------------------------------------------------
City | NAPPANEE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46550-9144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26017240A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------