Organization
COAL CITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E BEVERLY (OWNER)
(815) 634-2391
Entity
Organization
Contact information
Practice address
175 S BROADWAY ST, COAL CITY, IL 60416-1532
(815) 634-2391
Mailing address
175 S BROADWAY ST, COAL CITY, IL 60416-1532
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054007459
IL
Other
Enumeration date
05/11/2007
Last updated
07/30/2008
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