Organization
5 GUYS RX LLC
Active
Other names
WellCreek Pharmacy-Bethalto
Organization subpart
No
Provider details
NPI number
Authorized official
TAL ROZENE (PHARMACIST/OWNER)
(217) 994-1496
Entity
Organization
Contact information
Practice address
333 W BETHALTO DR STE B, BETHALTO, IL 62010-1909
(618) 377-5356
(855) 380-3588
Mailing address
333 W BETHALTO DR STE B, BETHALTO, IL 62010-1909
(618) 377-5356
(618) 377-0159
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.019904
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159604
PK
—
05
—
364151335001
—
IL
Enumeration date
05/09/2016
Last updated
12/01/2023
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