Organization
SOUTHERN ILLINOIS UNIVERSITY STUDENT
Active
Other names
SOUTHERN ILLINOIS UNIVERSITY STUDENT
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN CHANEY RPH (PHARMACY DIRECTOR)
(618) 453-4417
Entity
Organization
Contact information
Practice address
374 E GRAND AVE, CARBONDALE, IL 62901-3962
(618) 453-4417
(618) 453-4672
Mailing address
374 E GRAND AVE, CARBONDALE, IL 62901-3962
(618) 453-4417
(618) 453-4672
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
054.017089
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016773
PK
—
Enumeration date
06/20/2006
Last updated
04/11/2016
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