Provider Demographics
NPI:1376828103
Name:PFISTER, JOHN ROGER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROGER
Last Name:PFISTER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FAIRWAY VISTA RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-6402
Mailing Address - Country:US
Mailing Address - Phone:618-684-6662
Mailing Address - Fax:
Practice Address - Street 1:745 E VIENNA ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2041
Practice Address - Country:US
Practice Address - Phone:618-833-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.030563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist