Provider Demographics
NPI:1306508890
Name:JOHN'S PHARMACY INC
Entity type:Organization
Organization Name:JOHN'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-728-2331
Mailing Address - Street 1:102 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-2002
Mailing Address - Country:US
Mailing Address - Phone:217-728-2331
Mailing Address - Fax:217-728-2223
Practice Address - Street 1:102 E HARRISON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-2002
Practice Address - Country:US
Practice Address - Phone:217-728-2331
Practice Address - Fax:217-728-2223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN'S PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1932208907Medicaid