# VERNON ANDERSEN INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE SHOPPE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407867906
- **Authorized official:** MR. VERNON EUGENE ANDERSEN RPH (PRESIDENT)
- **Authorized official phone:** (618) 377-5356

## Contact information

- **Practice address:** 341 W BETHALTO DR, BETHALTO, IL 62010-1779
- **Practice address phone:** (618) 377-5356
- **Practice address fax:** (618) 377-0159
- **Mailing address:** 341 W BETHALTO DR, BETHALTO, IL 62010-1779
- **Mailing address phone:** (618) 377-5356
- **Mailing address fax:** (618) 377-0159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 054014647 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1467631 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 364151335001 | — | IL |