Healthcare Provider Details

I. General information

NPI: 1750400297
Provider Name (Legal Business Name): BEU HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY CIR
MACOMB IL
61455-1367
US

IV. Provider business mailing address

1 UNIVERSITY CIR
MACOMB IL
61455-1367
US

V. Phone/Fax

Practice location:
  • Phone: 309-298-1888
  • Fax: 309-298-2188
Mailing address:
  • Phone: 309-298-1888
  • Fax: 309-298-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number051.027214
License Number StateIL

VIII. Authorized Official

Name: MR. RONALD WARD
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 309-298-1811