Provider Demographics
NPI:1750455853
Name:PARIS CLINIC PHARMACY INC
Entity Type:Organization
Organization Name:PARIS CLINIC PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENEFIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-465-4114
Mailing Address - Street 1:719 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2478
Mailing Address - Country:US
Mailing Address - Phone:217-465-4114
Mailing Address - Fax:217-463-5801
Practice Address - Street 1:719 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2478
Practice Address - Country:US
Practice Address - Phone:217-465-4114
Practice Address - Fax:217-463-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1454521OtherNABP
IL=========OtherEIN
IL1454521OtherNABP
IL0209250001Medicare ID - Type Unspecified