Provider Demographics
NPI:1063217008
Name:BANZON, JILIAN ERYLL (RPH)
Entity type:Individual
Prefix:MR
First Name:JILIAN ERYLL
Middle Name:
Last Name:BANZON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BUCK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6721
Mailing Address - Country:US
Mailing Address - Phone:812-899-2307
Mailing Address - Fax:
Practice Address - Street 1:18 BUCK RIDGE DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-6721
Practice Address - Country:US
Practice Address - Phone:812-899-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26031143A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist