# ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST ELIZABETHS HOSPITAL OUTPATIENT PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366507485
- **Authorized official:** MARK D EVARD (VP OF REVENUE CYCLE)
- **Authorized official phone:** (217) 492-9651

## Contact information

- **Practice address:** 211 S 3RD ST, BELLEVILLE, IL 62220-1915
- **Practice address phone:** (618) 234-2120
- **Practice address fax:** (618) 222-4786
- **Mailing address:** 3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
- **Mailing address phone:** (618) 234-2120
- **Mailing address fax:** (618) 222-4786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054017328 051040885 | IL | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 10/31/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1470676 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |