David Wayne Secrest, RPH
Individual provider Active NPI Pharmacist · Bement, IL
NPI 1306113162 · NPPES record last updated Nov 22, 2011
Key facts
- NPI
- 1306113162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051-031147 (IL)
- Practice address
- 265 W Bond St
Bement, IL 61813-1404 - Phone
- (217) 493-9625
- NPI assigned
- Nov 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-031147 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051-031147 | IL | Yes |
Addresses
Primary practice location
265 W Bond St
Bement, IL 61813-1404
Mailing address
265 W Bond St
Bement, IL 61813-1404
Phone (217) 493-9625
Other providers in Bement, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.