Organization
SOUTHERN ILLINOIS HOSPITAL SERVICES
Active
Other names
Memorial Hospital of Carbondale
Organization subpart
No
Provider details
NPI number
Authorized official
TRISTA GIACOMO (PHARMACY MANAGER)
(618) 549-0721
Entity
Organization
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0475
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0475
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
054017053
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150884
PK
—
Enumeration date
04/07/2015
Last updated
04/07/2015
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