Organization
THE CARBONDALE CLINIC PHARMACY
Active
Parent organization
THE CARBONDALE CLINIC, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE CARBONDALE CLINIC, S.C.
Authorized official
MR. ALLAN NORMAN (CEO)
(618) 549-5361
Entity
Organization
Contact information
Practice address
2601 W MAIN ST, SUITE 101, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 549-5158
Mailing address
2601 W MAIN ST, SUITE 101, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 549-5158
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051-023018
IL
183500000X
Pharmacist
051-034485
IL
183700000X
Pharmacy Technician
049-083922
IL
183700000X
Pharmacy Technician
049-127699
IL
183700000X
Pharmacy Technician
049-156580
IL
183700000X
Pharmacy Technician
049-169519
IL
183700000X
Pharmacy Technician
049-173061
IL
3336C0003X
Community/Retail Pharmacy
Primary
0054-009512
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1296860001
MEDICARE LEGACY
IL
01
—
1454014
NABP
IL
Enumeration date
12/28/2006
Last updated
04/30/2008
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