Provider Demographics
NPI:1760838361
Name:SEARL, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SEARL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 JOHN DEERE EXPY
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1973
Mailing Address - Country:US
Mailing Address - Phone:309-792-5990
Mailing Address - Fax:
Practice Address - Street 1:1312 JOHN DEERE EXPY
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1973
Practice Address - Country:US
Practice Address - Phone:309-792-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.037948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist