Provider Demographics
NPI:1154910438
Name:HOOSER, JOHN DAVID (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:HOOSER
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 1:308 DRUSCILLA LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-5555
Mailing Address - Country:US
Mailing Address - Phone:618-558-5016
Mailing Address - Fax:
Practice Address - Street 1:308 DRUSCILLA LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-5555
Practice Address - Country:US
Practice Address - Phone:618-558-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043274183500000X
IL051-037467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist