Provider Demographics
NPI:1386798627
Name:DHS CENTRAL PHARMACY
Entity type:Organization
Organization Name:DHS CENTRAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUREAU CHIEF
Authorized Official - Prefix:MISS
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-785-8983
Mailing Address - Street 1:901 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5125
Mailing Address - Country:US
Mailing Address - Phone:217-558-0965
Mailing Address - Fax:217-558-2532
Practice Address - Street 1:901 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5125
Practice Address - Country:US
Practice Address - Phone:217-558-0965
Practice Address - Fax:217-558-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital