# GROCERIES OF SOUTHERN ILLINOIS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Freeburg pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528073178
- **Authorized official:** BRYAN VICTOR SCHNEIDER PHARMD (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (618) 207-3186

## Contact information

- **Practice address:** 10 SOUTHGATE CTR, FREEBURG, IL 62243-1541
- **Practice address phone:** (618) 539-5577
- **Practice address fax:** (618) 539-3089
- **Mailing address:** PO BOX 140, COLUMBIA, IL 62236-0140
- **Mailing address phone:** (618) 539-5577
- **Mailing address fax:** (618) 539-3089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054009538 | IL | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 06/01/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2019782 | PK | — |
| 05 | — | 371239582001 | — | IL |