Provider Demographics
NPI:1972885762
Name:CALHOUN, GARY CLARK JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:CLARK
Last Name:CALHOUN
Suffix:JR
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 1:6770 REAS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:IL
Mailing Address - Zip Code:62501-7064
Mailing Address - Country:US
Mailing Address - Phone:217-855-4827
Mailing Address - Fax:
Practice Address - Street 1:6770 REAS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:IL
Practice Address - Zip Code:62501-7064
Practice Address - Country:US
Practice Address - Phone:217-855-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.040873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist