Organization
ONCOLOGY-HEMATOLOGY ASSOCIATES OF CENTRAL ILLINOIS P C
Active
Other names
Illinois Cancer Care, PC
Organization subpart
No
Provider details
NPI number
Authorized official
JASON HARLOW (PHARMACIST)
(309) 243-3404
Entity
Organization
Contact information
Practice address
4391 VENTURE DR, PERU, IL 61354-1018
(309) 243-3403
(309) 243-3075
Mailing address
8940 N WOOD SAGE RD, PEORIA, IL 61615-7822
(309) 243-3019
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054019849
IL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160136
PK
—
Enumeration date
05/12/2016
Last updated
03/24/2017
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