Organization
EXTENDED PHARMACY LLC
Active
Other names
Extended Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SPIRES (MANAGER)
(309) 676-4831
Entity
Organization
Contact information
Practice address
121 STATE ST STE 1A, PEORIA, IL 61602-1547
(309) 676-4831
(309) 676-7014
Mailing address
121 STATE ST STE 1A, PEORIA, IL 61602-1547
(309) 676-4831
(309) 676-7014
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
64002202A
IN
3336L0003X
Long Term Care Pharmacy
Primary
054016704
IL
3336L0003X
Long Term Care Pharmacy
2015044792
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120962
PK
—
Enumeration date
07/01/2009
Last updated
03/14/2023
About Stedi
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