Illinois Family Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Breese, IL
NPI 1003658600 · NPPES record last updated Apr 21, 2025
Key facts
- NPI
- 1003658600
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ILLINOIS FAMILY PHARMACY LLC
- Practice address
- 117 Clintonian PLZ
Breese, IL 62230-1501 - Phone
- (618) 526-8040
- Fax
- (618) 526-8072
- NPI assigned
- Jun 12, 2024
- Organization subpart
- No
Authorized official
- Name
- Samantha Dryer
- Title
- Vice President
- Phone
- (618) 526-8040
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241114001977 | IL | Part B Supplier - Pharmacy | 9537693494 | Practice locations: Breese, IL |
| O20250513000812 | IL | DME Supplier - Pharmacy | 9537693494 | Practice locations: Breese, IL |
National Provider Directory
- Tax ID family
- Comprehensive Care Pharmacy
Locations
117 Clintonia PLZ
Breese, IL 62230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
117 Clintonian PLZ
Breese, IL 62230-1501
Mailing address
117 Clintonian PLZ
Breese, IL 62230-1501
Phone (618) 526-8040
Other names
- Comprehensive Care Pharmacy
Other providers in Breese, IL
- Olivia Hodges
- Courtney Hollenkamp
- HSHS Medical Group Inc
- Kara Ann Huegen
- Brett Lynn Hutcherson
- Illinois Family Pharmacy LLC
- Infinity-Meds LLP
- Travis Allen Isaak
- Clarece Rose Jansen
- Kelly Jean Kalmer
All providers in Breese, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.