Provider Demographics
NPI:1356668255
Name:FRENCH, GERALD DEWAYNE
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DEWAYNE
Last Name:FRENCH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:DEWAYNE
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2721 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1493
Mailing Address - Country:US
Mailing Address - Phone:217-443-1514
Mailing Address - Fax:217-443-1648
Practice Address - Street 1:2721 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1493
Practice Address - Country:US
Practice Address - Phone:217-443-1514
Practice Address - Fax:217-443-1648
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291662183500000X
IN26014026A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist