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General NPI Number Information
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NPI Number | 1982957403
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE HOLDING CO LLC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 201 N 5TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1001
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Country | US
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Telephone | 217-528-8096
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Fax | 217-528-8152
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Provider Business Mailing Address
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Address Line | 4650 INDUSTRIAL DR
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5318
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Country | US
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Telephone | 217-467-8281
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Fax | 217-467-8297
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Authorized Official
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Title or Position | PHARMACIST
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Name | JOHN ENDRIS
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Credential |
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Telephone | 217-528-8096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054.014959
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License Number State | IL
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