Organization
5 GUYS RX II LLC
Active
Other names
Wellcreek Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAL ROZENE (PRESIDENT)
(217) 994-1496
Entity
Organization
Contact information
Practice address
1 W LINCOLN AVE, CHARLESTON, IL 61920
(217) 512-2816
(844) 512-2573
Mailing address
913 NORTHWOOD DR, EFFINGHAM, IL 62401-5206
(217) 512-2816
(217) 512-2818
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.020171
IL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168642
PK
—
Enumeration date
10/20/2016
Last updated
08/14/2024
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