Provider Demographics
NPI:1184993180
Name:DEVILLIER, EUGENE B (BS)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:B
Last Name:DEVILLIER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 N 400TH RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66092-4010
Mailing Address - Country:US
Mailing Address - Phone:785-883-4897
Mailing Address - Fax:
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1744
Practice Address - Country:US
Practice Address - Phone:913-884-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09663183500000X
MO29484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist