Healthcare Provider Details

I. General information

NPI: 1134515844
Provider Name (Legal Business Name): CATHY FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 N VETERANS PKWY
BLOOMINGTON IL
61704-2201
US

IV. Provider business mailing address

1403 N VETERANS PKWY
BLOOMINGTON IL
61704-2201
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-3052
  • Fax: 309-662-7326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051035899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: