Provider Demographics
NPI:1255473187
Name:CARLE RX EXPRESS PHARMACY
Entity Type:Organization
Organization Name:CARLE RX EXPRESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHT
Authorized Official - Phone:217-762-4766
Mailing Address - Street 1:641 E MEYER ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-2118
Mailing Address - Country:US
Mailing Address - Phone:217-762-9046
Mailing Address - Fax:217-762-9401
Practice Address - Street 1:108 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1636
Practice Address - Country:US
Practice Address - Phone:217-762-4766
Practice Address - Fax:217-762-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty