Provider Demographics
NPI:1942728506
Name:HOWELL PHARMACY LLC
Entity Type:Organization
Organization Name:HOWELL PHARMACY LLC
Other - Org Name:MEDICINE SHOPPE PHARMACY 2119
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-206-8655
Mailing Address - Street 1:122 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1161
Mailing Address - Country:US
Mailing Address - Phone:618-206-8655
Mailing Address - Fax:618-589-3007
Practice Address - Street 1:122 W STATE ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1161
Practice Address - Country:US
Practice Address - Phone:618-206-8655
Practice Address - Fax:618-589-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540204513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy