Organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Active
Other names
CLYDE CHOATE MENTAL HEALTH DEVELOPMENTAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE ONSTOTT RPH (PHARMACY MANAGER)
(618) 202-6708
Entity
Organization
Contact information
Practice address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
(618) 833-3432
Mailing address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
(618) 833-3432
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054017322
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023357
PK
—
Enumeration date
01/22/2007
Last updated
12/07/2022
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