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General NPI Number Information
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NPI Number | 1750400297
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Entity Type | Organization
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Legal Business Name | BEU HEALTH CENTER PHARMACY
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY CIR
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City | MACOMB
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State | IL
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Zip | 61455-1367
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Country | US
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Telephone | 309-298-1888
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Fax | 309-298-2188
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Provider Business Mailing Address
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Address Line | 1 UNIVERSITY CIR
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City | MACOMB
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State | IL
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Zip | 61455-1367
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Country | US
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Telephone | 309-298-1888
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Fax | 309-298-2188
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS SERVICES
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Name | MR. RONALD WARD
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Credential |
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Telephone | 309-298-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 051.027214
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License Number State | IL
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