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General NPI Number Information
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NPI Number | 1760379465
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Entity Type | Organization
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Legal Business Name | DECATUR PHARMACYXPRESS LLC
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2499 N MONROE ST
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City | DECATUR
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State | IL
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Zip | 62526-3941
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Country | US
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Telephone | 217-615-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 621 WOLF RD
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City | DECATUR
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State | IL
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Zip | 62526-1148
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Country | US
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Telephone | 217-201-4726
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MAEN QATOUM
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Credential | PHARMD
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Telephone | 217-201-4726
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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 |
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License Number State |
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