Healthcare Provider Details

I. General information

NPI: 1295885218
Provider Name (Legal Business Name): HARMON'S DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MAIN ST
OBLONG IL
62449-0159
US

IV. Provider business mailing address

PO BOX 159
OBLONG IL
62449-0159
US

V. Phone/Fax

Practice location:
  • Phone: 618-592-4231
  • Fax: 618-592-4410
Mailing address:
  • Phone: 618-592-4231
  • Fax: 618-592-4410

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number051033226
License Number StateIL

VIII. Authorized Official

Name: BRAD HARMON
Title or Position: PRESIDENT/PHARMACIST
Credential:
Phone: 618-592-4231