Organization
BOGARD DRUG NO. 5, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE T NIMMO (CORPORATE SECRETARY)
(309) 637-4487
Entity
Organization
Contact information
Practice address
1102 S WESTERN AVE, PEORIA, IL 61605-3356
(309) 637-4487
(309) 637-9141
Mailing address
1102 S WESTERN AVE, PEORIA, IL 61605-3356
(309) 637-4487
(309) 637-9141
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1411191
NCPDP
IL
Enumeration date
05/10/2006
Last updated
08/22/2020
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