Organization
SENIOR MED SERVICES INC
Active
Other names
UVANTA Pharmacy-Southern Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN STOECKLIN (PRESIDENT)
(618) 993-2900
Entity
Organization
Contact information
Practice address
7846 AVIATION DR, MARION, IL 62959-5818
(618) 993-2900
(618) 998-1485
Mailing address
7846 AVIATION DR, MARION, IL 62959-5818
(618) 993-2900
(618) 998-1485
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
054017138
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477810
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/28/2006
Last updated
11/04/2010
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