Provider Demographics
NPI:1851486377
Name:METZGER, JOHN A
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:METZGER
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 1:28 EAST SECOND STREET
Mailing Address - Street 2:PO BOX 317
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557
Mailing Address - Country:US
Mailing Address - Phone:217-562-2011
Mailing Address - Fax:
Practice Address - Street 1:28 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557
Practice Address - Country:US
Practice Address - Phone:217-562-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist