Individual
JOHN DALE POWLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
121 W NORTH AVE, FLORA, IL 62839-1613
(618) 662-9470
Mailing address
4898 N IL 130, OLNEY, IL 62450-3738
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-036868
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051-036868
ILLINOIS BOARD OF PHARMACY
IL
Enumeration date
05/31/2017
Last updated
05/31/2017
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