Provider Demographics
NPI:1487137832
Name:LENA DRUG STORE, INC.
Entity type:Organization
Organization Name:LENA DRUG STORE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-745-3700
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-0454
Mailing Address - Country:US
Mailing Address - Phone:815-369-4111
Mailing Address - Fax:815-369-2602
Practice Address - Street 1:154 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-9247
Practice Address - Country:US
Practice Address - Phone:815-369-4111
Practice Address - Fax:815-369-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy