Provider Demographics
NPI:1023198785
Name:PHARMACY PLUS INC
Entity Type:Organization
Organization Name:PHARMACY PLUS INC
Other - Org Name:PHARMACY PLUS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:217-248-6868
Mailing Address - Street 1:213 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ROODHOUSE
Mailing Address - State:IL
Mailing Address - Zip Code:62082-1344
Mailing Address - Country:US
Mailing Address - Phone:217-589-4313
Mailing Address - Fax:217-589-5121
Practice Address - Street 1:213 W CLAY ST
Practice Address - Street 2:
Practice Address - City:ROODHOUSE
Practice Address - State:IL
Practice Address - Zip Code:62082-1344
Practice Address - Country:US
Practice Address - Phone:217-589-4313
Practice Address - Fax:217-589-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
IL0540196713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159108OtherPK
IL=========005Medicaid