Organization
PRAIRIE COMPOUNDING PHARMACIES CORPORATION
Active
Other names
Prairie Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANN ROHDE (PRESIDENT)
(217) 412-4408
Entity
Organization
Contact information
Practice address
2801 N MAIN ST, DECATUR, IL 62526-3233
(217) 412-4408
(217) 875-2000
Mailing address
3798 E FULTON AVE, DECATUR, IL 62521-5053
(217) 876-7455
(217) 875-2000
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054017639
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1485463
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/25/2011
Last updated
03/24/2011
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