Healthcare Provider Details

I. General information

NPI: 1588420616
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E GRANT STREET
MACOMB IL
61455
US

IV. Provider business mailing address

525 E GRANT STREET ATTN: MDH COMMUNITY PHARMACY
MACOMB IL
61455
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-8151
  • Fax:
Mailing address:
  • Phone: 516-639-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE CHRISTINA DZIUBA
Title or Position: DIRECTOR OF COMMUNITY PHARMACY
Credential: PHARMD
Phone: 516-639-8151