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Organization
EXTENDED LIVING PHARMACY LLC
Active
Organization
EXTENDED LIVING PHARMACY LLC
Active
Other names
EXTENDED LIVING PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY AUBRY RPH (MANAGER)
(217) 855-8378
Entity
Organization
Contact information
Practice address
338 W MARION AVE, FORSYTH, IL 62535-1064
(217) 875-7147
(217) 875-7081
Mailing address
338 W MARION AVE, FORSYTH, IL 62535-1064
(217) 875-7147
(217) 875-7081
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054016055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023265
PK
—
Enumeration date
10/03/2006
Last updated
03/13/2019
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