DOLAN CENTRAL ILLINOIS COMPOUNDING LLC (NPI# 1093883290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093883290 |
| Entity Type | Organization |
| Organization Name | DOLAN CENTRAL ILLINOIS COMPOUNDING LLC |
| Other Organization Name | PRECKSHOT PROFESSIONAL PHARMACY |
| Practice Address |
5832 N Knoxville Ave Ste E Peoria IL 61614-4304 |
| Practice Telephone | 3096792047 |
| Practice Fax Number | 3096792051 |
| Mailing Telephone | 3096792047 |
| Mailing Fax Number | 3096792051 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2018-07-19 |
| Authorized Official Name | COREY DOLAN (PHARMACIST) |
| Authorized Official Telephone | 3096792047 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | 054.020600 | IL | Suppliers |
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2099-43 | WI | Suppliers |
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
4394 | IA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2175601 | 01 |
| Other Name | Type Code |
|---|---|
| Preckshot Professional Pharmacy | Doing Business As Name - Organization |
| Street Address |
5832 N KNOXVILLE AVE STE E |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568970556 | Dolan Central Illinois Compounding Pharmacy LLC | Pharmacist | 5832 N Knoxville Ave Ste E, Peoria, IL 61614-4304 | 2018-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner’s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144858747 | Meta Pharmacy Solutions | Pharmacy | 8914 N 91st Ave Ste 100c, Peoria, AZ 85345-8390 | 2020-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851936132 | Aafiyah Solutions Inc | Pharmacy | 1041 W Golf Rd, Hoffman Estates, IL 60169-1339 | 2019-11-11 |
| 1265805592 | Professional Pharmacy Inc | Pharmacy | 2069 Barrington Rd, Hoffman Estates, IL 60169-2086 | 2015-11-09 |
| 1861880833 | Al-machnee Inc | Pharmacy | 7953 S Cicero Ave, Chicago, IL 60652-2037 | 2014-12-29 |
| 1083002034 | Premier Family Pharmacy Inc | Pharmacy | 5600 W 87th St Ste B, Burbank, IL 60459-2902 | 2014-12-29 |
| 1699189134 | Custom Care Pharmacy LLC | Pharmacy | 7007 North Ave, Oak Park, IL 60302-1001 | 2014-06-12 |
| 1588082127 | Bolingbrook Compounding Pharmacy | Pharmacy | 402 W Boughton Rd Ste C, Bolingbrook, IL 60440-1985 | 2014-04-01 |
| 1588906507 | Pill Shop Pharmacy Inc | Pharmacy | 3535 E New York St Ste 117, Aurora, IL 60504-4466 | 2013-03-18 |
| 1285970574 | Northern Rx LLC | Pharmacy | 2012 E. Nw Hwy., Arlington Heights, IL 60004 | 2012-12-14 |
| 1376802462 | Rock Valley Compounding Pharmacy LLC | Pharmacy | 811 S Perryville Rd Unit 109, Rockford, IL 61108-4323 | 2012-05-09 |
| 1306102728 | Propharm Rx Inc | Pharmacy | 115 S Macoupin St, Gillespie, IL 62033-1516 | 2012-04-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.