Provider Demographics
NPI:1861458812
Name:RINDERER'S HOME HEALTH CARE PHARMACY
Entity Type:Organization
Organization Name:RINDERER'S HOME HEALTH CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-928-3957
Mailing Address - Street 1:68 N BELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1794
Mailing Address - Country:US
Mailing Address - Phone:618-377-2151
Mailing Address - Fax:618-377-7966
Practice Address - Street 1:68 N BELLWOOD RD
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1794
Practice Address - Country:US
Practice Address - Phone:618-377-2151
Practice Address - Fax:618-377-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1430951OtherNCPDP
IL4308213905Medicaid
IL4308213905Medicaid