Provider Demographics
NPI:1558641282
Name:MCCALLISTER, BILLY J (PHARM D)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:J
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2537
Mailing Address - Country:US
Mailing Address - Phone:563-243-2247
Mailing Address - Fax:563-243-2331
Practice Address - Street 1:1905 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2537
Practice Address - Country:US
Practice Address - Phone:563-243-2247
Practice Address - Fax:563-243-2331
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist