Healthcare Provider Details

I. General information

NPI: 1386798627
Provider Name (Legal Business Name): DHS CENTRAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SOUTHWIND DR
SPRINGFIELD IL
62703-5125
US

IV. Provider business mailing address

901 SOUTHWIND DR
SPRINGFIELD IL
62703-5125
US

V. Phone/Fax

Practice location:
  • Phone: 217-558-0965
  • Fax: 217-558-2532
Mailing address:
  • Phone: 217-558-0965
  • Fax: 217-558-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MISS RANDY D. MALAN
Title or Position: BUREAU CHIEF
Credential:
Phone: 217-785-8983