Provider Demographics
NPI:1982957403
Name:INDEPENDENCE HOLDING CO LLC
Entity type:Organization
Organization Name:INDEPENDENCE HOLDING CO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-8096
Mailing Address - Street 1:4650 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5318
Mailing Address - Country:US
Mailing Address - Phone:217-467-8281
Mailing Address - Fax:217-467-8297
Practice Address - Street 1:201 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1001
Practice Address - Country:US
Practice Address - Phone:217-528-8096
Practice Address - Fax:217-528-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.014959333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy