NPI Code Detail JSON Logo

1760379465 NPI number — DECATUR PHARMACYXPRESS LLC

NPI Number: 1760379465
Health Care Provider/Practitioner: DECATUR PHARMACYXPRESS LLC

Information about “1760379465” NPI (DECATUR PHARMACYXPRESS LLC) exists in 1760379465 in HTML format HTML  |  1760379465 in plain Text format TXT  |  1760379465 in PDF (Portable Document Format) PDF  |  1760379465 in an XML format XML  formats.

NPI Number : 1760379465 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760379465",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DECATUR PHARMACYXPRESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "621 WOLF RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DECATUR",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62526-1148",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-201-4726",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2499 N MONROE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62526-3941",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-615-5100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2025",
    "LastUpdateDate": "07/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "QATOUM",
    "AuthorizedOfficialFirstName": "MAEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHARMD",
    "AuthorizedOfficialTelephoneNumber": "217-201-4726",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0003X",
        "TaxonomyName": "Community/Retail Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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