Organization
EXTENDED LIVING PHARMACY LLC
Active
Other names
EXTENDED LIVING PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY AUBRY RPH (MANAGER)
(217) 855-8378
Entity
Organization
Contact information
Practice address
338 W MARION AVE, FORSYTH, IL 62535-1064
(217) 875-7147
(217) 875-7081
Mailing address
338 W MARION AVE, FORSYTH, IL 62535-1064
(217) 875-7147
(217) 875-7081
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054016055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023265
PK
—
Enumeration date
10/03/2006
Last updated
03/13/2019
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