Provider Demographics
NPI:1033179668
Name:PHARMACY PLUS, INC.
Entity Type:Organization
Organization Name:PHARMACY PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-248-6868
Mailing Address - Street 1:502 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62044-1305
Mailing Address - Country:US
Mailing Address - Phone:217-368-2667
Mailing Address - Fax:217-368-3140
Practice Address - Street 1:502 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IL
Practice Address - Zip Code:62044-1305
Practice Address - Country:US
Practice Address - Phone:217-368-2667
Practice Address - Fax:217-368-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371380805001Medicaid
IL4538880001Medicare ID - Type UnspecifiedPROVIDER NUMBER