Brian E Duttlinger, RPH
Individual provider Active NPI Pharmacist · Peru, IL
NPI 1629113907 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629113907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- Practice address
- 920 West St
Peru, IL 61354-2763 - Phone
- (815) 224-4555
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 051039961 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | IL | Yes |
Addresses
Primary practice location
920 West St
Peru, IL 61354-2763
Mailing address
45 Brook View Dr
La Salle, IL 61301-9669
Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.