Provider Demographics
NPI:1679566301
Name:METCALFE, DALE R (RPH)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:METCALFE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:9205 CORNEILS ROAD
Mailing Address - City:BRISTOL
Mailing Address - State:IL
Mailing Address - Zip Code:60512-0124
Mailing Address - Country:US
Mailing Address - Phone:630-553-5064
Mailing Address - Fax:630-553-5064
Practice Address - Street 1:9205 CORNEILS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IL
Practice Address - Zip Code:60512-9771
Practice Address - Country:US
Practice Address - Phone:630-553-5064
Practice Address - Fax:630-553-5064
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist