Provider Demographics
NPI:1851763924
Name:BOBROWSKI INDUSTRIES PRINCETON LLC
Entity Type:Organization
Organization Name:BOBROWSKI INDUSTRIES PRINCETON LLC
Other - Org Name:FAWCETTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-599-5515
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-1000
Mailing Address - Country:US
Mailing Address - Phone:606-599-5515
Mailing Address - Fax:
Practice Address - Street 1:519 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2006
Practice Address - Country:US
Practice Address - Phone:815-872-3251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540147513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy