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Organization
GROCERIES OF SOUTHERN ILLINOIS LLC
Active
Organization
GROCERIES OF SOUTHERN ILLINOIS LLC
Active
Other names
new athens pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN SCHNEIDER PHARMD (DIRECTOR OF PHARMACY)
(618) 539-5577
Entity
Organization
Contact information
Practice address
901 SPOTSYLVANIA ST, NEW ATHENS, IL 62264-1569
(618) 566-6843
(618) 475-9219
Mailing address
10 SOUTHGATE CTR, FREEBURG, IL 62243-1541
(618) 539-5577
(618) 539-3089
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054018344
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143033
PK
—
05
—
371239582001
—
IL
Enumeration date
11/27/2013
Last updated
10/15/2021
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