| NAME |
PEORIA PHARMACY |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
7717 N ORANGE PRAIRIE RD |
| CITY |
PEORIA |
| ZIP |
61615-9323 |
| OFFICIAL VA NAME |
PEORIA PHARMACY |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PEORIA VA CLINIC PHARMACY |
| EFFECTIVE DATE/TIME |
-
- 2006-08-22 00:00:00
- STATUS: ACTIVE
- NPI: 1336197284
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 7717 NORTH ORANGE PRAIRIE DRIVE
- CITY (CHANGED FROM): PEORIA
- STATE (CHANGED FROM): ILLINOIS
- ZIP (CHANGED FROM): 61615-9323
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1336197284
|
