Provider Demographics
NPI:1932298874
Name:BROMENN HEALTHCARE PHARMACY
Entity Type:Organization
Organization Name:BROMENN HEALTHCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-268-5199
Mailing Address - Street 1:PO BOX 2850
Mailing Address - Street 2:PHARMACY
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-2850
Mailing Address - Country:US
Mailing Address - Phone:309-268-5199
Mailing Address - Fax:309-888-0902
Practice Address - Street 1:1304 FRANKLIN AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-268-5199
Practice Address - Fax:309-888-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital