Healthcare Provider Details

I. General information

NPI: 1841495702
Provider Name (Legal Business Name): NATURALMED APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 W CHERRY ST
MARION IL
62959-1998
US

IV. Provider business mailing address

1008 W CHERRY ST
MARION IL
62959-1998
US

V. Phone/Fax

Practice location:
  • Phone: 618-969-9600
  • Fax:
Mailing address:
  • Phone: 618-969-9600
  • Fax: 618-969-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-016113
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number054-016113
License Number StateIL

VIII. Authorized Official

Name: ERIK THOMAS CORNETT
Title or Position: PIC/OWNER
Credential: RPH
Phone: 618-969-9600