Organization
BRENT FAMILY PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NATALIE J JOHNSON R.PH. (PHARMACIST IN CHARGE)
(309) 873-2965
Entity
Organization
Contact information
Practice address
1204 HIGHWAY 164 EAST, OQUAWKA, IL 61469-0289
(309) 867-3784
Mailing address
1204 HIGHWAY 164 EAST, PO BOX 289, OQUAWKA, IL 61469-0198
(309) 867-3784
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-016326
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20809904001
—
IL
Enumeration date
09/11/2007
Last updated
07/11/2008
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