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General NPI Number Information
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NPI Number | 1518436757
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Entity Type | Organization
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Legal Business Name | ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 1641 BROADWAY ST
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City | PEKIN
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State | IL
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Zip | 61554-3805
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Country | US
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Telephone | 309-243-3014
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Fax | 309-243-3032
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Provider Business Mailing Address
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Address Line | 8940 N WOOD SAGE RD
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City | PEORIA
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State | IL
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Zip | 61615-7822
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Country | US
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Telephone | 309-243-3403
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | JASON HARLOW
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Credential | PHARMD
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Telephone | 309-243-3403
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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 | 3336S0011X
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Taxonomy Name | Specialty 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 | 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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