=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194762674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONOHOO PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 S STATE ST
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61008-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-544-3433
-----------------------------------------------------
Fax | 815-547-6644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 S STATE ST
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61008-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-544-3433
-----------------------------------------------------
Fax | 815-547-6644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | MR. PATRICK S DONOHOO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 815-544-3433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 054011329
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 054011329
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------