NPIMap

Organization Active NPI

Pavilion Pharmacy West

  • Pharmacist
  • Springfield, IL
National Provider Identifier
1063483451
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
Legal business name
PAVILION PHARMACY WEST
Practice address
2901 Old Jacksonville Rd
Springfield, IL 62704-7437
Phone
(217) 698-3888
Fax
(217) 698-7649
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Quin C Hostetler, R. PH.
Title
Manager
Phone
(217) 698-3888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X IL Primary

Addresses

Primary practice location

2901 Old Jacksonville Rd
Springfield, IL 62704-7437

Mailing address

2901 Old Jacksonville Rd
Springfield, IL 62704-7437
Phone (217) 698-3888

National Provider Directory

National Provider Directory
Tax ID family
Pavilion Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063483451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-3888",
            "fax_number": "217-698-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-3888",
            "fax_number": "217-698-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION PHARMACY WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOSTETLER",
        "authorized_official_first_name": "QUIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-698-3888",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.