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Organization
OKAWVILLE PHARMACY
Active
Organization
OKAWVILLE PHARMACY
Active
Other names
OKAWVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TIM RALLO RPH (PRESIDENT)
(618) 243-6228
Entity
Organization
Contact information
Practice address
403 N HANOVER, OKAWVILLE, IL 62271
(618) 243-6228
(618) 243-5608
Mailing address
403 N HANOVER, P.O. BOX 424, OKAWVILLE, IL 62271
(618) 243-6228
(628) 243-5608
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054011091
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1438680
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
1485374
NCPDP
IL
05
—
371134674001
—
IL
Enumeration date
10/10/2006
Last updated
06/08/2011
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