Healthcare Provider Details

I. General information

NPI: 1205250412
Provider Name (Legal Business Name): BECKS LONG TERM CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 LOCUST STREET
ELDORADO IL
62930
US

IV. Provider business mailing address

1413 LOCUST ST.
ELDORADO IL
62930
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-2612
  • Fax: 618-273-5328
Mailing address:
  • Phone: 618-273-2612
  • Fax: 618-273-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054-018435
License Number StateIL

VIII. Authorized Official

Name: MR. JASON VINCENT KASIAR
Title or Position: OWNER
Credential: R.PH.
Phone: 618-273-2612