Organization
GOOD SAMARITAN REGIONAL HEALTH CENTER
Active
Other names
Good Samaritan Plaza Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELL R. ELLIS (PHARMACIST IN CHARGE)
(618) 899-4999
Entity
Organization
Contact information
Practice address
2 GOOD SAMARITAN WAY, SUITE 120, MOUNT VERNON, IL 62864-2475
(618) 899-4999
(618) 899-4799
Mailing address
2 GOOD SAMARITAN WAY, SUITE 120, MOUNT VERNON, IL 62864-2475
(618) 899-4999
(618) 899-4799
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.018065
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487556
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/05/2012
Last updated
02/28/2013
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