Healthcare Provider Details

I. General information

NPI: 1457362956
Provider Name (Legal Business Name): PRESCRIPTION SHOPPE OF CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W VAN BUREN ST
CLINTON IL
61727-2235
US

IV. Provider business mailing address

211 W VAN BUREN ST
CLINTON IL
61727-2235
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-8333
  • Fax: 217-935-6243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARY HIMSTEDT
Title or Position: PRESIDENT
Credential: RPH
Phone: 217-935-8333