Provider Demographics
NPI:1194762674
Name:DONOHOO PHARMACY INC.
Entity type:Organization
Organization Name:DONOHOO PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DONOHOO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-544-3433
Mailing Address - Street 1:216 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3617
Mailing Address - Country:US
Mailing Address - Phone:815-544-3433
Mailing Address - Fax:815-547-6644
Practice Address - Street 1:216 S STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3617
Practice Address - Country:US
Practice Address - Phone:815-544-3433
Practice Address - Fax:815-547-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X, 332B00000X
IL054011329333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid