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General NPI Number Information
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NPI Number | 1396871794
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Entity Type | Organization
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Legal Business Name | CAHOKIA PHARMACY INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 817 UPPER CAHOKIA RD
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City | CAHOKIA
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State | IL
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Zip | 62206-1211
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Country | US
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Telephone | 618-332-1028
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Fax | 618-332-7028
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Provider Business Mailing Address
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Address Line | 233 HICKORY RDG
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City | BELLEVILLE
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State | IL
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Zip | 62223-3443
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Country | US
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Telephone | 618-920-0295
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Fax |
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | ENRICO BERTUCCI
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Credential | RPH
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Telephone | 618-332-1028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054009531
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 054009531
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License Number State | IL
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Taxonomy #3
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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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