Individual
JERRY MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 W MAIN ST, CARMI, IL 62821-1387
(618) 382-4636
(618) 382-7970
Mailing address
202 APRIL AVE, CARMI, IL 62821-1545
(618) 382-8150
(618) 382-7970
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
IL
Other
Enumeration date
06/20/2006
Last updated
07/08/2007
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