Organization
DOLAN CENTRAL ILLINOIS COMPOUNDING PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY DOLAN PHARM D (OWNER/PHARMACY MANAGER)
(309) 679-2047
Entity
Organization
Contact information
Practice address
5832 N KNOXVILLE AVE STE E, PEORIA, IL 61614-4304
(309) 679-2047
(309) 679-2051
Mailing address
5832 N KNOXVILLE AVE STE E, PEORIA, IL 61614-4304
(309) 679-2047
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
—
Other
Enumeration date
01/12/2018
Last updated
03/19/2018
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