Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Other names
DHS CENTRAL OUTPATIENT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KATAUSKI (DIR OF PHRM)
(217) 786-6982
Entity
Organization
Contact information
Practice address
901 SOUTHWIND DR, SPRINGFIELD, IL 62703-5125
(217) 558-0965
(217) 558-2532
Mailing address
901 SOUTHWIND DR, SPRINGFIELD, IL 62703-5125
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
054014602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1480590
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/09/2007
Last updated
02/11/2009
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