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General NPI Number Information
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NPI Number | 1942501432
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Entity Type | Organization
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Legal Business Name | BRENT FAMILY PHARMACY INC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 101 S DIVISION ST # 150
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City | STRONGHURST
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State | IL
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Zip | 61480-5033
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Country | US
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Telephone | 309-924-2300
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Fax | 309-924-2302
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Provider Business Mailing Address
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Address Line | 101 S DIVISION ST BOX 150
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City | STRONGHURST
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State | IL
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Zip | 61480-5033
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Country | US
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Telephone | 309-924-2300
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Fax | 309-924-2302
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | NATALIE JOHNSON
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Credential | RPH
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Telephone | 309-924-2300
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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 | 054.017495
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License Number State | IL
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