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General NPI Number Information
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NPI Number | 1578868360
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Entity Type | Organization
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Legal Business Name | PRAIRIE COMPOUNDING PHARMACIES CORPORATION
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 2801 N MAIN ST
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City | DECATUR
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State | IL
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Zip | 62526-3233
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Country | US
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Telephone | 217-412-4408
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Fax | 217-875-2000
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Provider Business Mailing Address
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Address Line | 3798 E FULTON AVE
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City | DECATUR
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State | IL
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Zip | 62521-5053
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Country | US
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Telephone | 217-876-7455
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Fax | 217-875-2000
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANN ROHDE
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Credential |
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Telephone | 217-412-4408
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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 | 054017639
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License Number State | IL
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