Healthcare Provider Details

I. General information

NPI: 1306306105
Provider Name (Legal Business Name): HARMON'S DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MAIN ST
OBLONG IL
62449-1412
US

IV. Provider business mailing address

PO BOX 159
OBLONG IL
62449-0159
US

V. Phone/Fax

Practice location:
  • Phone: 618-592-4231
  • Fax: 618-592-4231
Mailing address:
  • Phone: 618-592-4231
  • Fax: 618-592-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD E HARMON
Title or Position: OWNER
Credential:
Phone: 618-592-4231