Individual
BROCKTON STOTLAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 889-6956
Mailing address
4300 CYPRESS GROVE PL, MARION, IL 62959-6651
(618) 889-6956
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.304659
IL
183500000X
Pharmacist
2013027406
MO
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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