Healthcare Provider Details

I. General information

NPI: 1851483564
Provider Name (Legal Business Name): PEORIA COUNTY DRUGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N STATE ROUTE 91 SUITE 100
PEORIA IL
61615-9541
US

IV. Provider business mailing address

8600 N STATE ROUTE 91 SUITE 100
PEORIA IL
61615-9541
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-9800
  • Fax: 309-691-3305
Mailing address:
  • Phone: 309-691-9800
  • Fax: 309-691-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. WAYNE R BEEKMAN
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 309-691-9800