Healthcare Provider Details

I. General information

NPI: 1568574911
Provider Name (Legal Business Name): PRN PHARMACIES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST
RIDGWAY IL
62979-1210
US

IV. Provider business mailing address

304 S COMMERCIAL ST
HARRISBURG IL
62946-2108
US

V. Phone/Fax

Practice location:
  • Phone: 618-272-3841
  • Fax: 618-272-3851
Mailing address:
  • Phone: 618-252-5349
  • Fax: 618-252-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203001134
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.016650
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD LEDBETTER
Title or Position: VICE PRESIDENT
Credential:
Phone: 618-252-5349