Healthcare Provider Details

I. General information

NPI: 1376464248
Provider Name (Legal Business Name): EDWARD JOSEPH MACHALA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST NW
BOURBONNAIS IL
60914-2303
US

IV. Provider business mailing address

24140 S SCHOOLHOUSE RD
MANHATTAN IL
60442-9591
US

V. Phone/Fax

Practice location:
  • Phone: 815-929-0590
  • Fax: 815-929-1433
Mailing address:
  • Phone: 815-929-0590
  • Fax: 815-929-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309070
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: