Provider Demographics
NPI:1538672449
Name:WEAR LTC
Entity Type:Organization
Organization Name:WEAR LTC
Other - Org Name:WEAR LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:217-357-9327
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-0305
Mailing Address - Country:US
Mailing Address - Phone:217-357-9327
Mailing Address - Fax:217-357-9225
Practice Address - Street 1:527 N MADISON ST STE B
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1034
Practice Address - Country:US
Practice Address - Phone:217-357-1210
Practice Address - Fax:217-357-4740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEAR DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid