Individual
BRET BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 W LAKE AVE, PEORIA, IL 61614-5968
(309) 682-2761
(309) 682-4267
Mailing address
901 W LAKE AVE, PEORIA, IL 61614-5968
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051038938
IL
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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