Provider Demographics
NPI:1821591207
Name:HARRY'S PHARMACY, INC
Entity Type:Organization
Organization Name:HARRY'S PHARMACY, INC
Other - Org Name:HARRY'S PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNTREGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-438-6141
Mailing Address - Street 1:620 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615-9784
Mailing Address - Country:US
Mailing Address - Phone:217-438-6141
Mailing Address - Fax:217-438-3447
Practice Address - Street 1:620 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615-9784
Practice Address - Country:US
Practice Address - Phone:217-438-6141
Practice Address - Fax:217-438-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540111223336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176447OtherPK