Organization
HARDIN COUNTY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ETIENNE (OWNER/PIC/AO)
(618) 285-6618
Entity
Organization
Contact information
Practice address
226 S ADAMS ST, GOLCONDA, IL 62938-1109
(618) 683-8253
(618) 683-8239
Mailing address
7 FERRELL RD, ROSICLARE, IL 62982-1006
(618) 285-6618
(618) 285-3147
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054020682
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175582
PK
—
Enumeration date
01/24/2018
Last updated
06/01/2018
Update your record
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