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Organization
PINE STREET PHARMACIES
Active
Organization
PINE STREET PHARMACIES
Active
Other names
STACY'S FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE STACY RPH (OWNER)
(217) 735-1972
Entity
Organization
Contact information
Practice address
709 WOODLAWN RD, LINCOLN, IL 62656-1445
(217) 735-1972
(217) 732-9827
Mailing address
709 WOODLAWN RD, LINCOLN, IL 62656-1445
(217) 735-1972
(217) 732-9827
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054.016477
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019679
PK
—
Enumeration date
01/11/2007
Last updated
01/08/2015
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