Provider Demographics
NPI:1740230481
Name:G M ANDES LTD
Entity Type:Organization
Organization Name:G M ANDES LTD
Other - Org Name:ANDES HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-342-9393
Mailing Address - Street 1:805 W FAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2415
Mailing Address - Country:US
Mailing Address - Phone:217-342-9393
Mailing Address - Fax:217-342-9409
Practice Address - Street 1:805 W FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2415
Practice Address - Country:US
Practice Address - Phone:217-342-9393
Practice Address - Fax:217-342-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540140353336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019673OtherPK
IL371236737001Medicaid
2019673OtherPK