Healthcare Provider Details

I. General information

NPI: 1285312132
Provider Name (Legal Business Name): KATILYN NIHISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S WALNUT ST
ARTHUR IL
61911-1284
US

IV. Provider business mailing address

2131 S RICHMOND RD
DECATUR IL
62521-4867
US

V. Phone/Fax

Practice location:
  • Phone: 217-543-2913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.297662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: