1093766230 NPI number — MR. RICHARD EUGENE MEESE II RPH

Table of content: MR. RICHARD EUGENE MEESE II RPH (NPI 1093766230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093766230 NPI number — MR. RICHARD EUGENE MEESE II RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEESE
Provider First Name:
RICHARD
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093766230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 DELMAR DR
Provider Second Line Business Mailing Address:
P.O. BOX 78
Provider Business Mailing Address City Name:
CATLIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61817-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N LOGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-3741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-443-2306
Provider Business Practice Location Address Fax Number:
217-431-5590
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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