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Organization
GROCERIES OF SOUTHERN ILLINOIS LLC
Active
Organization
GROCERIES OF SOUTHERN ILLINOIS LLC
Active
Other names
Freeburg pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN VICTOR SCHNEIDER PHARMD (DIRECTOR OF PHARMACY)
(618) 207-3186
Entity
Organization
Contact information
Practice address
10 SOUTHGATE CTR, FREEBURG, IL 62243-1541
(618) 539-5577
(618) 539-3089
Mailing address
PO BOX 140, COLUMBIA, IL 62236-0140
(618) 539-5577
(618) 539-3089
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054009538
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019782
PK
—
05
—
371239582001
—
IL
Enumeration date
07/30/2006
Last updated
06/01/2022
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