Provider Demographics
NPI:1528178720
Name:PRN PHARMACIES LTD
Entity Type:Organization
Organization Name:PRN PHARMACIES LTD
Other - Org Name:MEDICINE SHOPPE #503
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-252-5349
Mailing Address - Street 1:304 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2108
Mailing Address - Country:US
Mailing Address - Phone:618-252-5349
Mailing Address - Fax:618-252-1395
Practice Address - Street 1:304 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2108
Practice Address - Country:US
Practice Address - Phone:618-252-5349
Practice Address - Fax:618-252-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203001032332B00000X
IL054007872333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========503Medicaid
IL=========503Medicaid