Healthcare Provider Details

I. General information

NPI: 1255242764
Provider Name (Legal Business Name): SHAWNEE HEALTH SERVICE & DEVELOPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S DIVISION ST STE 200
CARTERVILLE IL
62918-1539
US

IV. Provider business mailing address

1006 S DIVISION ST STE 200
CARTERVILLE IL
62918-1539
US

V. Phone/Fax

Practice location:
  • Phone: 618-519-9200
  • Fax:
Mailing address:
  • Phone: 618-519-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID KEITH SMILEY
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 618-519-9200