Organization
PHARMAX INC.
Active
Other names
dba Pharmax Pharmacy #9907
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY T MCINTOSH (PRESIDENT)
(314) 954-5510
Entity
Organization
Contact information
Practice address
925 N WESTERN AVE, WEST PEORIA, IL 61604-5129
(309) 676-4421
Mailing address
925 N WESTERN AVE, WEST PEORIA, IL 61604-5129
(309) 676-4421
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054014717
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1426217
NCPDP #
IL
Enumeration date
08/31/2006
Last updated
03/07/2023
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