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General NPI Number Information
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NPI Number | 1801921267
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Entity Type | Individual
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Provider Name | JOHN ROSS MITTERMANN RPH
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 1400 HARRISON ST
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City | QUINCY
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State | IL
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Zip | 62301-6706
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Country | US
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Telephone | 217-222-2930
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Fax |
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Provider Business Mailing Address
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Address Line | 211 MORGAN ST
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City | KEOKUK
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State | IA
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Zip | 52632-5942
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Country | US
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Telephone | 319-572-8003
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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 | 051-028824
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License Number State | IL
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