Healthcare Provider Details

I. General information

NPI: 1093876013
Provider Name (Legal Business Name): JENNINGS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E MAIN ST
OLNEY IL
62450-2625
US

IV. Provider business mailing address

1029 E MAIN ST
OLNEY IL
62450-2625
US

V. Phone/Fax

Practice location:
  • Phone: 618-395-2144
  • Fax: 618-392-5075
Mailing address:
  • Phone: 618-395-2144
  • Fax: 618-392-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: DENNIS LEE JENNINGS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 618-395-2144