MT VERNON COMMUNITY PHARMACY INC (NPI# 1417923012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1417923012 |
Entity Type | Organization |
Organization Name | MT VERNON COMMUNITY PHARMACY INC |
Other Organization Name | THE MEDICINE SHOPPE |
Practice Address |
2339 Broadway St Mount Vernon IL 62864-2925 |
Practice Telephone | 6182428776 |
Mailing Telephone | 6182428776 |
Enumeration Date | 2006-02-24 |
Last Update Date | 2011-11-01 |
Authorized Official Name | ERIC BLACK (OWNER) |
Authorized Official Telephone | 6182428776 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
054016737 | IL | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NCPDP PROVIDER IDENTIFICATION NUMBER | 1447792 | 01 | |
BLUE CROSS BLUE SHIELD | 4132021 | 01 | |
HEALTHLINK | 334555 | 01 |
Other Name | Type Code |
---|---|
The Medicine Shoppe | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811543648 | Mt Vernon Community Pharmacy Inc | Pharmacy | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2019-08-16 |
Street Address |
2339 BROADWAY ST |
City | MOUNT VERNON |
State | IL |
Zip Code | 62864-2925 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811543648 | Mt Vernon Community Pharmacy Inc | Pharmacy | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2019-08-16 |
1598877961 | Eric Lee Black | Pharmacist | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2006-08-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
Find all providers in zip 62864 |
Taxonomy Code | 3336C0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Community/Retail Pharmacy |
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114545571 | Medlife Pharmacy LLC | Pharmacy | 213 Highway 37 Ste 200&300, Mount Vernon, TX 75457-3106 | 2020-07-10 |
1396175345 | Allcare PC | Pharmacy | 115 Spring St, Mount Vernon, GA 30445 | 2013-11-12 |
1811040918 | Brown & Cole Stores LLC | Pharmacy | 1515 N 18th St, Mount Vernon, WA 98273-2675 | 2007-01-19 |
1649374695 | Marco Pharmacy and Optical Inc | Pharmacy | 4121 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2006-09-12 |
1992808695 | Hook Superx LLC | Pharmacy | 700 E 4th St, Mount Vernon, IN 47620-2011 | 2006-09-07 |
1467555235 | Highland Park Cvs, L.L.C. | Pharmacy | 2700 Broadway St, Mount Vernon, IL 62864-2342 | 2006-09-07 |
1316970650 | Haggen, Inc | Pharmacy | 2601 E Division St, Mount Vernon, WA 98274-4748 | 2006-07-09 |
1619592763 | Knox Community Hospital | Pharmacy | 1330 Coshocton Ave, Mount Vernon, OH 43050-1495 | 2020-06-15 |
1639644156 | Mabd Enterprises, LLC | Pharmacy | 115 W Spring St, Mount Vernon, GA 30445-2957 | 2018-10-11 |
1952827537 | Walgreen Co | Pharmacy | 47 E Prospect Ave, Mount Vernon, NY 10550-2225 | 2017-08-16 |
Find all providers in MOUNT VERNON |
City | MOUNT VERNON |
Zip Code | 62864 |
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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.