Organization
NAUVOO PHARMACY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTIE ANN HAAS PHARMD (PHARMACIST/OWNER)
(217) 453-2717
Entity
Organization
Contact information
Practice address
1350 MULHOLLAND STREET, NAUVOO, IL 62354
(217) 453-2717
(217) 453-6456
Mailing address
PO BOX 248, 1350 MULHOLLAND STREET, NAUVOO, IL 62354
(217) 453-2717
(217) 453-6456
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054007478
IL
3336C0003X
Community/Retail Pharmacy
Primary
054007478
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3711031796235401
—
IL
Enumeration date
03/27/2009
Last updated
02/17/2023
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