Southern Illinois University Student

NPI 1124064035 - Pharmacy - 3336I0012X

NPI Details
NPI 1124064035
Enumeration Date 06/20/2006
Last Updated 04/11/2016
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name SUSAN SUSAN
Position PHARMACY DIRECTOR
Phone (618) 453-4417
Fax (618) 453-4672
Practice Location
374 E GRAND AVE
CARBONDALE IL, 62901-3962, US
Phone (618) 453-4417
Fax (618) 453-4672
Business Location
374 E GRAND AVE
CARBONDALE IL, 62901-3962, US
Phone (618) 453-4417
Fax (618) 453-4672
Toxanomy
Taxonomy Code 3336I0012X
License State Illinois
License Number 054017089
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According to our database, Southern Illinois University Student NPI is 1124064035, taxonomy code is 3336I0012X and license number is 054017089, license state is located at Illinois. Southern Illinois University Student physically located at 374 E Grand Ave, Carbondale IL, 62901-3962. NPI Number 1033115704 has the healthcare provider type.

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1124064035 NPI number is provided on an as is basis without warranty of any kind. 1124064035 is maintained by the National Plan & Provider Enumeration System. The contents of Southern Illinois University Student are for informational purposes only.