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Organization
LAKE OF DECATUR, INC
Active
Organization
LAKE OF DECATUR, INC
Active
Other names
Colee's Corner Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
DALE COLEE (OWNER)
(217) 429-5165
Entity
Organization
Contact information
Practice address
845 S ROUTE 51, UNIT B, FORSYTH, IL 62535-9759
(217) 330-9552
(217) 791-6280
Mailing address
845 S ROUTE 51, UNIT B, FORSYTH, IL 62535-9759
(217) 330-9552
(217) 791-6280
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-018441
IL
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Enumeration date
12/12/2013
Last updated
02/20/2020
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