Healthcare Provider Details

I. General information

NPI: 1306977699
Provider Name (Legal Business Name): HOPEDALE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TREMONT ST.
HOPEDALE IL
61747
US

IV. Provider business mailing address

107 TREMONT ST.
HOPEDALE IL
61747
US

V. Phone/Fax

Practice location:
  • Phone: 309-449-4330
  • Fax: 309-449-4336
Mailing address:
  • Phone: 309-449-4330
  • Fax: 309-449-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054017195
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number093013390
License Number StateIL

VIII. Authorized Official

Name: DR. LISA ANNETTE ROSSI-MCLAUGHLIN
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 309-449-4330