Healthcare Provider Details

I. General information

NPI: 1770687782
Provider Name (Legal Business Name): HIDEG PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W MAIN ST STE 104
BELLEVILLE IL
62223-1788
US

IV. Provider business mailing address

8601 W MAIN ST STE 104
BELLEVILLE IL
62223-1788
US

V. Phone/Fax

Practice location:
  • Phone: 618-398-4400
  • Fax: 618-398-4401
Mailing address:
  • Phone: 618-398-4400
  • Fax: 618-398-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054009963
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054009963
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DAY
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 618-398-4400