Healthcare Provider Details

I. General information

NPI: 1093068553
Provider Name (Legal Business Name): INDEPENDENCE HOLDING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

IV. Provider business mailing address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

V. Phone/Fax

Practice location:
  • Phone: 217-483-2496
  • Fax: 217-483-5772
Mailing address:
  • Phone: 217-483-2496
  • Fax: 217-483-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.014841
License Number StateIL

VIII. Authorized Official

Name: JOHN ENDRIS
Title or Position: PHARMACIST
Credential:
Phone: 217-528-8096