Provider Demographics
NPI:1811933013
Name:SENIOR CARE PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:SENIOR CARE PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-762-3950
Mailing Address - Street 1:1212 BEAR LN
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-9581
Mailing Address - Country:US
Mailing Address - Phone:217-762-3950
Mailing Address - Fax:207-762-7039
Practice Address - Street 1:1212 BEAR LN
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-9581
Practice Address - Country:US
Practice Address - Phone:217-762-3950
Practice Address - Fax:207-762-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0169563336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021606OtherPK
IA200498260AMedicaid
IL232963282004Medicaid
MO606162303Medicaid