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General NPI Number Information
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NPI Number | 1235525270
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS HOSPITAL SERVICES
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 405 W JACKSON ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1462
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Country | US
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Telephone | 618-549-0721
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Fax | 618-529-0475
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Provider Business Mailing Address
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Address Line | 405 W JACKSON ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1462
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Country | US
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Telephone | 618-549-0721
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Fax | 618-529-0475
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | TRISTA GIACOMO
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Credential |
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Telephone | 618-549-0721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 054017053
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License Number State | IL
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