MEDICARE: MR. ROBERT C POWLESS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1326119595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C POWLESS RPH

Provider Business Mailing Address
First Line	:	3 BROOK LN
Second Line	:	PO BOX 577
City	:	FLORA
State	:	IL
Zip	:	62839-2608
Country	:	US
Telephone Number	:	618-662-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 E NORTH AVE
Second Line	:
City	:	FLORA
State	:	IL
Zip	:	62839-2028
Country	:	US
Telephone Number	:	618-662-2174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. ROBERT C POWLESS RPH” Practice Location

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