Provider Demographics
NPI:1598760902
Name:PHARMACY CENTER INC.
Entity Type:Organization
Organization Name:PHARMACY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-244-2171
Mailing Address - Street 1:101 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-1031
Mailing Address - Country:US
Mailing Address - Phone:815-244-2171
Mailing Address - Fax:815-244-1174
Practice Address - Street 1:101 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1031
Practice Address - Country:US
Practice Address - Phone:815-244-2171
Practice Address - Fax:815-244-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-014023333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid