Provider Demographics
NPI:1821373085
Name:MCILHONE, BRIAN FRANCIS (RPH,)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:MCILHONE
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 1:902 LEXINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2104
Mailing Address - Country:US
Mailing Address - Phone:608-850-4065
Mailing Address - Fax:
Practice Address - Street 1:7941 TREE LN STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2029
Practice Address - Country:US
Practice Address - Phone:608-833-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11175-40183500000X
IL051.290425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist