Provider Demographics
NPI:1164639845
Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:SARAH D. CULBERTSON MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-322-4321
Mailing Address - Street 1:238 S CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1465
Mailing Address - Country:US
Mailing Address - Phone:217-322-4321
Mailing Address - Fax:217-322-4246
Practice Address - Street 1:238 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1465
Practice Address - Country:US
Practice Address - Phone:217-322-4321
Practice Address - Fax:217-322-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0590068383336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-69635OtherNCPDP