Organization
HAC 4 LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NORMA HOLTZ (PHARMACY MANAGER)
(309) 928-2491
Entity
Organization
Contact information
Practice address
217 S MAIN ST, FARMER CITY, IL 61842-1455
(309) 928-2491
(309) 928-2493
Mailing address
217 S MAIN ST, FARMER CITY, IL 61842-1455
(309) 928-2491
(309) 928-2493
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054019646
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155868
PK
—
Enumeration date
12/15/2015
Last updated
04/04/2017
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