<Unavail>

LBN: Extended Pharmacy Llc
<Unavail> is an health care organization with primary practice located at 121 State St Ste 1A , Peoria IL 61602-1547. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Long Term Care Pharmacy is the primary health care specialty. Extended Pharmacy Llc can be contacted via phone (309) 676-4831, or through Spires, Eric via phone (309) 676-4831.

Contact Information

Primary practice address
121 State St Ste 1A Peoria IL 61602-1547
Phone: (309) 676-4831
Fax: (309) 676-7014
Website:
Map and Directions
Authorized official contact:
Name: Spires, Eric
Phone: (309) 676-4831

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 64002202A Indiana
Suppliers / Long Term Care Pharmacy 3336L0003X 054016704 Illinois
Suppliers / Long Term Care Pharmacy 3336L0003X 2015044792 Missouri

Profile Details

NPI number 1700014446
LBN Legal business name Extended Pharmacy Llc
DBA Doing business as <Unavail>
Authorized official Spires, Eric
Entity Organization
Organization subpart 1 No
Enumeration date Jul 1st, 2009
Last updated Mar 14th, 2023 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700014446 NPPES
Other 2120962 PK

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