Healthcare Provider Details

I. General information

NPI: 1497406219
Provider Name (Legal Business Name): CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MCKINLEY AVE STE 6
DECATUR IL
62526-5858
US

IV. Provider business mailing address

210 W MCKINLEY AVE STE 6
DECATUR IL
62526-5858
US

V. Phone/Fax

Practice location:
  • Phone: 217-329-3239
  • Fax:
Mailing address:
  • Phone: 217-329-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. PERRY GUAGLIANONE
Title or Position: DIRECTOR OF PHARMACY
Credential: MD
Phone: 217-876-6600