Healthcare Provider Details

I. General information

NPI: 1295078137
Provider Name (Legal Business Name): PHARMACY PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MAIN ST
WHITE HALL IL
62092-1054
US

IV. Provider business mailing address

116 N MAIN ST
WHITE HALL IL
62092-1054
US

V. Phone/Fax

Practice location:
  • Phone: 217-374-2222
  • Fax: 217-374-2220
Mailing address:
  • Phone: 217-374-2222
  • Fax: 217-374-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054018147
License Number StateIL

VIII. Authorized Official

Name: MR. BYRON A. BERRY JR.
Title or Position: PRESIDENT
Credential: RPH
Phone: 217-942-3427