Provider Demographics
NPI:1104817048
Name:ESKER, ANTHONY LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LEE
Last Name:ESKER
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 1:324 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:STEELEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62288-1407
Mailing Address - Country:US
Mailing Address - Phone:618-965-3511
Mailing Address - Fax:618-965-3553
Practice Address - Street 1:711 E BROADWAY
Practice Address - Street 2:
Practice Address - City:STEELEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62288-1733
Practice Address - Country:US
Practice Address - Phone:618-965-9180
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371239284001Medicaid
IL1456587OtherNCPDP NUMBER
IL1456587OtherNCPDP NUMBER