Organization
HOLISTIC PHARMACY SERVICES OF JACKSONVILLE INC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BEAUX COLE (PRESIDENT)
(217) 371-2925
Entity
Organization
Contact information
Practice address
200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
(217) 245-1551
(217) 245-6825
Mailing address
200 W MORTON AVE, JACKSONVILLE, IL 62650-2812
(217) 245-1551
(217) 245-6825
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054018947
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149933
PK
—
Enumeration date
11/14/2014
Last updated
02/21/2017
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