Organization
BENNER FAMILY PHARMACY
Active
Other names
THE PHARMACY STOP
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GROESBECK III RPH (PRESIDENT)
(815) 434-5355
Entity
Organization
Contact information
Practice address
113 W MICHIGAN ST, OTTAWA, IL 61350-2028
(815) 434-5355
(815) 434-9457
Mailing address
113 W MICHIGAN ST, OTTAWA, IL 61350-2028
(815) 434-5355
(815) 434-9457
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
203000583
IL
3336C0003X
Community/Retail Pharmacy
Primary
054013074
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1454711
NCPDP
—
01
—
403344
JOINT COMMISSION ACCREDIT
—
Enumeration date
07/11/2006
Last updated
12/26/2019
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