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General NPI Number Information
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NPI Number | 1366536773
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH SYSTEM CORPORATION
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2000 LAKE AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-7401
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Country | US
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Telephone | 815-337-4116
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Fax | 815-337-4795
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Provider Business Mailing Address
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Address Line | 1010 N WASHINGTON ST
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City | JANESVILLE
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State | WI
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Zip | 53548-1561
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOSPEH D MALAS
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Credential |
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Telephone | 815-971-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 54014068
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License Number State | IL
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