# PRAIRIE COMPOUNDING PHARMACIES CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prairie Compounding Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578868360
- **Authorized official:** ANN ROHDE (PRESIDENT)
- **Authorized official phone:** (217) 412-4408

## Contact information

- **Practice address:** 2801 N MAIN ST, DECATUR, IL 62526-3233
- **Practice address phone:** (217) 412-4408
- **Practice address fax:** (217) 875-2000
- **Mailing address:** 3798 E FULTON AVE, DECATUR, IL 62521-5053
- **Mailing address phone:** (217) 876-7455
- **Mailing address fax:** (217) 875-2000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054017639 | IL | Yes |

## Other

- **Enumeration date:** 01/25/2011
- **Last updated:** 03/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1485463 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |