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General NPI Number Information
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NPI Number | 1841270386
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Entity Type | Organization
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Legal Business Name | POLYCLINIC PHARMACY INC
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 707 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-446-3784
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Fax | 217-446-0370
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Provider Business Mailing Address
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Address Line | 707 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-446-3784
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Fax | 217-446-0370
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. INDERJIT S RAKALLA
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Credential | R.PH.
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Telephone | 217-446-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054009124
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License Number State | IL
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