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General NPI Number Information
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NPI Number | 1720356421
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Entity Type | Organization
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Legal Business Name | KEWANEE HOSPITAL PHARMACY
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1051 W SOUTH ST
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City | KEWANEE
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State | IL
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Zip | 61443-8354
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Country | US
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Telephone | 309-852-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 WEST SOUTH STREET P O BOX 747
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City | KEWANEE
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State | IL
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Zip | 61443-0747
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Country | US
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Telephone | 309-852-7890
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Fax |
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | MRS. MARGARET GUSTAFSON
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Credential |
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Telephone | 309-852-7520
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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 | 054017368
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License Number State | IL
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