Individual
JON ANTHONY POORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2701 E 3RD ST, BLOOMINGTON, IN 47401-5433
(812) 332-1419
Mailing address
6089 ACORN DR, COLUMBUS, IN 47201-8446
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26026285A
IN
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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