Provider Demographics
NPI:1104957000
Name:SHUPENUS, JAMES ALLAN (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLAN
Last Name:SHUPENUS
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 1:422 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1032
Mailing Address - Country:US
Mailing Address - Phone:217-742-9485
Mailing Address - Fax:
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1249
Practice Address - Country:US
Practice Address - Phone:217-742-3149
Practice Address - Fax:217-742-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-26247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist