Provider Demographics
NPI:1396959938
Name:PRINCETON PHARMACY, INC
Entity type:Organization
Organization Name:PRINCETON PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-875-1237
Mailing Address - Street 1:610 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2006
Mailing Address - Country:US
Mailing Address - Phone:815-875-1237
Mailing Address - Fax:815-872-1747
Practice Address - Street 1:610 N MAIN STREET
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:815-875-1237
Practice Address - Fax:815-872-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL540149333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1430090OtherNCPDP
1430090OtherNCPDP
1430090OtherNCPDP