Beverly, Thomas E

Beverly, Thomas E is an sole proprietor health care provider with primary practice located at 175 S Broadway St , Coal City IL 60416-1532. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Beverly, Thomas E can be contacted via phone (815) 634-2391.

Contact Information

Primary practice address
175 S Broadway St Coal City IL 60416-1532
Phone: (815) 634-2391
Fax: (815) 634-2729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X Illinois

Profile Details

NPI number 1548301500
LBN Legal business name Beverly, Thomas E
Credentials R.PH.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 10th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548301500 NPPES
Illinois MEDICAID 363134286001

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