Healthcare Provider Details

I. General information

NPI: 1053463059
Provider Name (Legal Business Name): ONCOLOGY-HEMATOLOGY ASSOCIATES OF CENTRAL ILLINOIS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

IV. Provider business mailing address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3405
  • Fax: 309-243-3075
Mailing address:
  • Phone: 309-243-3405
  • Fax: 309-243-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016528
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON HARLOW
Title or Position: PHCY MGER,AO
Credential: PHARMD
Phone: 309-243-3404