Provider Demographics
NPI:1124306634
Name:HELD, DAVID WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:HELD
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 1:104 MALVERN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2743
Mailing Address - Country:US
Mailing Address - Phone:309-888-4212
Mailing Address - Fax:
Practice Address - Street 1:104 MALVERN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2743
Practice Address - Country:US
Practice Address - Phone:309-888-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist