Provider Demographics
NPI:1457414864
Name:BELL, JEAN MARIE (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N EUGENE AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:IN
Mailing Address - Zip Code:47928-8175
Mailing Address - Country:US
Mailing Address - Phone:765-492-3628
Mailing Address - Fax:217-431-7979
Practice Address - Street 1:2300 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1735
Practice Address - Country:US
Practice Address - Phone:217-431-7975
Practice Address - Fax:217-431-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051040694OtherREGISTEREDPHARMACIST