Provider Demographics
NPI:1205924024
Name:MERCER COUNTY HOSPITAL PHARMACY
Entity type:Organization
Organization Name:MERCER COUNTY HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-582-5301
Mailing Address - Street 1:409 N.W. 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231
Mailing Address - Country:US
Mailing Address - Phone:309-582-5301
Mailing Address - Fax:309-582-3737
Practice Address - Street 1:409 N.W. 9TH AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231
Practice Address - Country:US
Practice Address - Phone:309-582-5301
Practice Address - Fax:309-582-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1452755OtherNCPDP