Provider Demographics
NPI:1700289808
Name:HARMON'S DRUG STORE, INC
Entity Type:Organization
Organization Name:HARMON'S DRUG STORE, INC
Other - Org Name:HARMON'S HEALTH MART PALESTINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-586-5010
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:IL
Mailing Address - Zip Code:62451-1263
Mailing Address - Country:US
Mailing Address - Phone:618-586-5010
Mailing Address - Fax:618-586-5012
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:IL
Practice Address - Zip Code:62451-1263
Practice Address - Country:US
Practice Address - Phone:618-586-5010
Practice Address - Fax:618-586-5012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARMON'S DRUG STORE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0336220002Medicare NSC