# HOLISTIC PHARMACY SERVICES OF JACKSONVILLE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Medicine Shoppe Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942606132
- **Authorized official:** BEAUX COLE (PRESIDENT)
- **Authorized official phone:** (217) 371-2925

## Contact information

- **Practice address:** 200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
- **Practice address phone:** (217) 245-1551
- **Practice address fax:** (217) 245-6825
- **Mailing address:** 200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
- **Mailing address phone:** (217) 245-1551
- **Mailing address fax:** (217) 245-6825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054018947 | IL | Yes |

## Other

- **Enumeration date:** 11/14/2014
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2149933 | PK | — |