Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
PETERSBURG PHARMACY, INC
Active
Organization
PETERSBURG PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BAGOT RPH (PHARMACIST/OWNER)
(217) 632-7777
Entity
Organization
Contact information
Practice address
1 CENTRE DR, SUITE 100, PETERSBURG, IL 62675-9467
(217) 632-7777
(217) 632-7618
Mailing address
1 CENTRE DR, SUITE 100, PETERSBURG, IL 62675-9467
(217) 632-7777
(217) 632-7618
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.015430
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054.015430
DIV 1 PHARMACY LICENSE
IL
01
—
120007769
MEDCO PROVIDER NUMBER
IL
01
—
1477745
NABP NUMBER
IL
01
—
320.008365
CONTROLLED SUB LIC #
IL
01
—
3574-5932
STATE ID NUMBER
IL
Enumeration date
10/13/2006
Last updated
06/02/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers