Organization
ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL ILLINOIS
Active
Other names
Illinois Cancer Care
Organization subpart
No
Provider details
NPI number
Authorized official
JASON HARLOW (PHARMACIST IN CHARGE)
(309) 243-3404
Entity
Organization
Contact information
Practice address
3105 MAGORY DRIVE, BLOOMINGTON, IL 61704
(309) 243-9018
(309) 243-3075
Mailing address
3105 MAGORY DRIVE, BLOOMINGTON, IL 61704
(309) 243-9018
(309) 243-3075
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.019361
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152589
PK
—
Enumeration date
06/24/2015
Last updated
06/24/2015
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