NPI 1194247080 · live from the CMS NPI Registry
11 South Medical Pharmacy, LLC
Pharmacy in Columbia, IL. National Provider Identifier 1194247080, active.
NPI record
| NPI | 1194247080 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy 333600000X |
| Practice location | 1000 Eleven South, Ste 2b, Columbia, IL 62236 |
| Practice phone | 618-281-3500 |
| Mailing address | 1000 Eleven S Ste 2b, Columbia, IL 62236 |
| Enumerated | July 12, 2017 |
| Last updated | July 28, 2017 |
| Authorized official | Kelsie Lider, Pharmacy Manager |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pharmacy primary | 333600000X | 054020346 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.