Organization
BENNER FAMILY PHARMACY INC
Active
Other names
THE PHARMACY STOP MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GROESBECK (PRESIDENT)
(815) 434-5355
Entity
Organization
Contact information
Practice address
1614 E NORRIS DR, OTTAWA, IL 61350-3681
(815) 433-4666
(815) 433-4719
Mailing address
1614 E NORRIS DR, OTTAWA, IL 61350-3681
(815) 433-4666
(815) 433-4719
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054016665
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1460233
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/18/2006
Last updated
11/20/2009
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