# GOOD SAMARITAN REGIONAL HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Good Samaritan Plaza Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316282163
- **Authorized official:** MICHELL R. ELLIS (PHARMACIST IN CHARGE)
- **Authorized official phone:** (618) 899-4999

## Contact information

- **Practice address:** 2 GOOD SAMARITAN WAY, SUITE 120, MOUNT VERNON, IL 62864-2475
- **Practice address phone:** (618) 899-4999
- **Practice address fax:** (618) 899-4799
- **Mailing address:** 2 GOOD SAMARITAN WAY, SUITE 120, MOUNT VERNON, IL 62864-2475
- **Mailing address phone:** (618) 899-4999
- **Mailing address fax:** (618) 899-4799

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054.018065 | IL | Yes |

## Other

- **Enumeration date:** 12/05/2012
- **Last updated:** 02/28/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1487556 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |