Organization
BRATLAND'S PRESCRIPTION SHOP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEO BRATLAND RPH (PRESIDENT)
(217) 442-2472
Entity
Organization
Contact information
Practice address
8 E NORTH ST, DANVILLE, IL 61832-5804
(217) 442-2472
(217) 442-2477
Mailing address
8 E NORTH ST, DANVILLE, IL 61832-5804
(217) 442-2472
(217) 442-2477
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5410069
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1459999
NABP
—
01
—
5410069
PHARMACY LICEASE
IL
Enumeration date
02/01/2006
Last updated
03/07/2023
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