Organization
INDEPENDENCE HOLDING CO LLC
Active
Other names
Complete Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CHRISTOPHER SMITH (EXECUTIVE V.P.)
(217) 753-1688
Entity
Organization
Contact information
Practice address
14 E WASHINGTON ST STE C, CHAMPAIGN, IL 61820-3677
(217) 355-6607
(217) 355-6639
Mailing address
14 E WASHINGTON ST STE C, CHAMPAIGN, IL 61820-3677
(217) 355-6607
(217) 355-6639
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054-018086
IL
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-018086
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-018801
STATE LICENSE NUMBER
IL
Enumeration date
12/12/2012
Last updated
09/26/2014
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