# GROCERIES OF SOUTHERN ILLINOIS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** new athens pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841620960
- **Authorized official:** DR. BRYAN SCHNEIDER PHARMD (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (618) 539-5577

## Contact information

- **Practice address:** 901 SPOTSYLVANIA ST, NEW ATHENS, IL 62264-1569
- **Practice address phone:** (618) 566-6843
- **Practice address fax:** (618) 475-9219
- **Mailing address:** 10 SOUTHGATE CTR, FREEBURG, IL 62243-1541
- **Mailing address phone:** (618) 539-5577
- **Mailing address fax:** (618) 539-3089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054018344 | IL | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 10/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2143033 | PK | — |
| 05 | — | 371239582001 | — | IL |