Provider Demographics
NPI:1518436757
Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:309-243-3403
Mailing Address - Street 1:8940 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-3403
Mailing Address - Fax:
Practice Address - Street 1:1641 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3805
Practice Address - Country:US
Practice Address - Phone:309-243-3014
Practice Address - Fax:309-243-3032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054020985OtherSTATE LICENSE