Healthcare Provider Details

I. General information

NPI: 1487137832
Provider Name (Legal Business Name): LENA DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W MAIN ST
LENA IL
61048-9247
US

IV. Provider business mailing address

PO BOX 454
LENA IL
61048-0454
US

V. Phone/Fax

Practice location:
  • Phone: 815-369-4111
  • Fax: 815-369-2602
Mailing address:
  • Phone: 815-369-4111
  • Fax: 815-369-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KARRIE SABINSON
Title or Position: OWNER
Credential:
Phone: 815-745-3700