Organization
CAHOKIA PHARMACY INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
ENRICO BERTUCCI RPH (OWNER PHARMACIST)
(618) 332-1028
Entity
Organization
Contact information
Practice address
817 UPPER CAHOKIA RD, CAHOKIA, IL 62206-1211
(618) 332-1028
(618) 332-7028
Mailing address
233 HICKORY RDG, BELLEVILLE, IL 62223-3443
(618) 920-0295
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054009531
IL
333600000X
Pharmacy
054009531
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1456676
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/27/2007
Last updated
03/07/2023
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