Organization
GROCERIES OF SOUTHERN ILLINOIS LLC
Active
Other names
Freeburg pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN VICTOR SCHNEIDER PHARMD (DIRECTOR OF PHARMACY)
(618) 207-3186
Entity
Organization
Contact information
Practice address
10 SOUTHGATE CTR, FREEBURG, IL 62243-1541
(618) 539-5577
(618) 539-3089
Mailing address
PO BOX 140, COLUMBIA, IL 62236-0140
(618) 539-5577
(618) 539-3089
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054009538
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019782
PK
—
05
—
371239582001
—
IL
Enumeration date
07/30/2006
Last updated
06/01/2022
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