Provider Demographics
NPI:1215523881
Name:DEAL, JOHN EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:DEAL
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 1:810 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-1927
Mailing Address - Country:US
Mailing Address - Phone:936-348-2731
Mailing Address - Fax:936-348-9121
Practice Address - Street 1:810 S STATE ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-1927
Practice Address - Country:US
Practice Address - Phone:936-348-2731
Practice Address - Fax:936-348-9121
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist