Organization
HARRYS PHARMACY INC
Active
Other names
Carroll Street Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT BORNTREGER RPH (VICE-PRESIDENT)
(217) 627-7000
Entity
Organization
Contact information
Practice address
707 CARROLL ST STE B, PAWNEE, IL 62558-9661
(217) 627-7000
(217) 438-3447
Mailing address
620 E JACKSON ST, AUBURN, IL 62615-9784
(217) 438-6141
(217) 438-3447
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-17453
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1484310
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/30/2010
Last updated
07/14/2010
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