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General NPI Number Information
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NPI Number | 1487749560
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Entity Type | Organization
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Legal Business Name | CHRISTIE PHARMACY CHAMPAIGN LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 101 W UNIVERSITY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3909
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Country | US
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Telephone | 217-366-1278
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Fax | 217-366-6897
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Provider Business Mailing Address
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Address Line | 101 W UNIVERSITY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3909
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Country | US
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Telephone | 217-366-1278
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Fax | 217-366-6897
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DAVE DUMMLER
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Credential |
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Telephone | 217-366-1278
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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 |
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License Number State |
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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 | 054016506
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License Number State | IL
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