Provider Demographics
NPI:1750325577
Name:EISELE, JAMES V (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:EISELE
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 1:255 JULIA PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1218
Mailing Address - Country:US
Mailing Address - Phone:618-398-6579
Mailing Address - Fax:
Practice Address - Street 1:200 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1438
Practice Address - Country:US
Practice Address - Phone:618-345-0188
Practice Address - Fax:618-345-2452
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040348183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist