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Organization
INDEPENDENCE HOLDING CO LLC
Active
Organization
INDEPENDENCE HOLDING CO LLC
Active
Other names
Complete Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CHRISTOPHER SMITH (EXECUTIVE V.P.)
(217) 753-1688
Entity
Organization
Contact information
Practice address
14 E WASHINGTON ST STE C, CHAMPAIGN, IL 61820-3677
(217) 355-6607
(217) 355-6639
Mailing address
14 E WASHINGTON ST STE C, CHAMPAIGN, IL 61820-3677
(217) 355-6607
(217) 355-6639
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054-018086
IL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054-018086
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-018801
STATE LICENSE NUMBER
IL
Enumeration date
12/12/2012
Last updated
09/26/2014
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