Provider Demographics
NPI:1447852314
Name:ROUNSAVILLE, JARRON (PHARMD)
Entity type:Individual
Prefix:
First Name:JARRON
Middle Name:
Last Name:ROUNSAVILLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 N VERMILION ST STE A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-5997
Mailing Address - Country:US
Mailing Address - Phone:217-443-9587
Mailing Address - Fax:
Practice Address - Street 1:4101 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-5997
Practice Address - Country:US
Practice Address - Phone:217-443-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist