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General NPI Number Information
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NPI Number | 1205078847
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Entity Type | Organization
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Legal Business Name | NAUVOO PHARMACY, PLLC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 1350 MULHOLLAND STREET
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City | NAUVOO
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State | IL
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Zip | 62354
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Country | US
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Telephone | 217-453-2717
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Fax | 217-453-6456
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Provider Business Mailing Address
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Address Line | PO BOX 248 1350 MULHOLLAND STREET
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City | NAUVOO
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State | IL
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Zip | 62354
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Country | US
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Telephone | 217-453-2717
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Fax | 217-453-6456
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MATTIE ANN HAAS
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Credential | PHARMD
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Telephone | 217-453-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 054007478
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054007478
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License Number State | IL
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