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General NPI Number Information
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NPI Number | 1972525970
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Entity Type | Organization
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Legal Business Name | ALTON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 1 MEMORIAL DR
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City | ALTON
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State | IL
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Zip | 62002-6722
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Country | US
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Telephone | 618-463-7610
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Fax | 618-463-7722
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Provider Business Mailing Address
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Address Line | 1 MEMORIAL DR
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City | ALTON
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State | IL
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Zip | 62002-6722
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Country | US
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Telephone | 618-463-7610
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Fax | 618-463-7722
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | KELLY MUELLER
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Credential |
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Telephone | 618-463-7425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 054017172
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License Number State | IL
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