Provider Demographics
NPI:1710260948
Name:DETERS, JAMES A (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:DETERS
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 1:701 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1737
Mailing Address - Country:US
Mailing Address - Phone:419-222-9462
Mailing Address - Fax:419-222-8345
Practice Address - Street 1:701 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1737
Practice Address - Country:US
Practice Address - Phone:419-222-9462
Practice Address - Fax:419-222-8345
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
OH03318237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03318237OtherPHARMACY LICENSE #