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Organization
HOLISTIC PHARMACY SERVICES OF JACKSONVILLE INC
Active
Organization
HOLISTIC PHARMACY SERVICES OF JACKSONVILLE INC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BEAUX COLE (PRESIDENT)
(217) 371-2925
Entity
Organization
Contact information
Practice address
200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
(217) 245-1551
(217) 245-6825
Mailing address
200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
(217) 245-1551
(217) 245-6825
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054018947
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149933
PK
—
Enumeration date
11/14/2014
Last updated
02/21/2017
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