Organization
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Other names
ST ELIZABETHS HOSPITAL OUTPATIENT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D EVARD (VP OF REVENUE CYCLE)
(217) 492-9651
Entity
Organization
Contact information
Practice address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
(618) 222-4786
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(618) 234-2120
(618) 222-4786
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054017328 051040885
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1470676
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/27/2006
Last updated
10/31/2024
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