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Organization
BENNER FAMILY PHARMACY
Active
Organization
BENNER FAMILY PHARMACY
Active
Other names
THE PHARMACY STOP
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GROESBECK III RPH (PRESIDENT)
(815) 434-5355
Entity
Organization
Contact information
Practice address
113 W MICHIGAN ST, OTTAWA, IL 61350-2028
(815) 434-5355
(815) 434-9457
Mailing address
113 W MICHIGAN ST, OTTAWA, IL 61350-2028
(815) 434-5355
(815) 434-9457
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
203000583
IL
3336C0003X
Community/Retail Pharmacy
Primary
054013074
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1454711
NCPDP
—
01
—
403344
JOINT COMMISSION ACCREDIT
—
Enumeration date
07/11/2006
Last updated
12/26/2019
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