Provider Demographics
NPI:1609851260
Name:MAPLE, JAMES BALLEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BALLEW
Last Name:MAPLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2210 NORTHSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-9769
Mailing Address - Country:US
Mailing Address - Phone:217-824-1668
Mailing Address - Fax:217-824-1671
Practice Address - Street 1:201 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1562
Practice Address - Country:US
Practice Address - Phone:217-824-1668
Practice Address - Fax:217-824-1671
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist