Provider Demographics
NPI:1770925901
Name:HEATON, JAMES BRECKINRIDGE II (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRECKINRIDGE
Last Name:HEATON
Suffix:II
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 1:200 PITTSFIELD RD # B
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1626
Mailing Address - Country:US
Mailing Address - Phone:217-770-2437
Mailing Address - Fax:217-773-2832
Practice Address - Street 1:200 PITTSFIELD RD # B
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1626
Practice Address - Country:US
Practice Address - Phone:217-770-2437
Practice Address - Fax:217-773-2832
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-027569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist