Provider Demographics
NPI:1932245149
Name:SCHOTTS PHARMACY INC
Entity Type:Organization
Organization Name:SCHOTTS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT RDO
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZELIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:815-795-2700
Mailing Address - Street 1:800 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-1342
Mailing Address - Country:US
Mailing Address - Phone:815-795-2700
Mailing Address - Fax:815-795-2379
Practice Address - Street 1:800 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1342
Practice Address - Country:US
Practice Address - Phone:815-795-2700
Practice Address - Fax:815-795-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540304333336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1124330001Medicare NSC