Provider Demographics
NPI:1306306105
Name:HARMON'S DRUG STORE, INC
Entity type:Organization
Organization Name:HARMON'S DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:618-592-4231
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-0159
Mailing Address - Country:US
Mailing Address - Phone:618-592-4231
Mailing Address - Fax:618-592-4250
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1412
Practice Address - Country:US
Practice Address - Phone:618-592-4231
Practice Address - Fax:618-592-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy