Provider Demographics
NPI:1124710645
Name:SOUTHERN ILLINOIS HEALTHCARE
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PARRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-942-2171
Mailing Address - Street 1:201 S 14TH ST RM 1-342
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3631
Mailing Address - Country:US
Mailing Address - Phone:618-942-2171
Mailing Address - Fax:
Practice Address - Street 1:201 S 14TH ST RM 1-342
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERRIN HOSPITAL PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy