Provider Demographics
NPI:1992911317
Name:LEVAN, JAMES HERBERT (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HERBERT
Last Name:LEVAN
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 1:3605 TOWNSHIP ROAD 108
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43324-9613
Mailing Address - Country:US
Mailing Address - Phone:937-686-9957
Mailing Address - Fax:
Practice Address - Street 1:120 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLS POINT
Practice Address - State:OH
Practice Address - Zip Code:43348
Practice Address - Country:US
Practice Address - Phone:937-843-2048
Practice Address - Fax:937-843-2371
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist