Organization
PROPHARM RX INC
Active
Other names
PROPHARM RX INC
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE SULLIVAN (SEC/TRES)
(217) 839-2909
Entity
Organization
Contact information
Practice address
115 S MACOUPIN ST, GILLESPIE, IL 62033-1516
(217) 839-3233
(217) 839-3233
Mailing address
113 S MACOUPIN ST, POB 59, GILLESPIE, IL 62033-1516
(217) 839-2909
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1486617
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/10/2012
Last updated
04/11/2012
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