1598975005 NPI number — CURTIS BRUCE SHERMAN RPH

Table of content: CURTIS BRUCE SHERMAN RPH (NPI 1598975005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598975005 NPI number — CURTIS BRUCE SHERMAN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERMAN
Provider First Name:
CURTIS
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1598975005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15014 W WINCHESTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIMFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61517-9319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-446-9025
Provider Business Mailing Address Fax Number:
309-446-9696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 KNOXVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIMFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-446-3292
Provider Business Practice Location Address Fax Number:
309-446-9696
Provider Enumeration Date:
05/23/2007

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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