Individual
BRENT D HERRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2610 N PROSPECT AVE, CHAMPAIGN, IL 61822-1251
(217) 352-1490
(317) 352-1490
Mailing address
2610 N PROSPECT AVE, CHAMPAIGN, IL 61822-1251
(217) 352-1490
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051302607
IL
183500000X
Pharmacist
26023781A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162420
NABP
—
Enumeration date
11/03/2020
Last updated
11/03/2020
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