Provider Demographics
NPI:1043364870
Name:CHESTER MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CHESTER MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:618-826-4571
Mailing Address - Street 1:1315 LEHMEN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-2542
Mailing Address - Country:US
Mailing Address - Phone:618-826-4571
Mailing Address - Fax:618-826-5823
Practice Address - Street 1:1315 LEHMEN DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-2542
Practice Address - Country:US
Practice Address - Phone:618-826-4571
Practice Address - Fax:618-826-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL059007736283Q00000X
3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No283Q00000XHospitalsPsychiatric Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy