Provider Demographics
NPI:1467735712
Name:WEST, JOHN WILSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILSON
Last Name:WEST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 N BELT W
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4618
Mailing Address - Country:US
Mailing Address - Phone:618-277-4440
Mailing Address - Fax:618-277-5857
Practice Address - Street 1:5890 N BELT W
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4618
Practice Address - Country:US
Practice Address - Phone:618-277-4440
Practice Address - Fax:618-277-5857
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist