Active NPI
Pharmax Inc.
Doing business as dba Pharmax Pharmacy #9907
- Community/Retail Pharmacy
- West Peoria, IL
National Provider Identifier
1073625679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 054014717
- Legal business name
- PHARMAX INC.
- Doing business as
- dba Pharmax Pharmacy #9907
- Practice address
- 925 N Western Ave
West Peoria, IL 61604-5129 - Phone
- (309) 676-4421
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Larry T McIntosh
- Title
- President
- Phone
- (314) 954-5510
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 054014717 | IL | Primary |
Addresses
Primary practice location
925 N Western Ave
West Peoria, IL 61604-5129
Mailing address
925 N Western Ave
West Peoria, IL 61604-5129
Phone (309) 676-4421
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1426217 | Other | IL | NCPDP # |
Other names 1
- dba Pharmax Pharmacy #9907
National Provider Directory
National Provider Directory- Tax ID family
- Dba Pharmax Pharmacy 1302
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
Locations
925 N Western Ave
West Peoria, IL 61604
Phone (309) 676-4421
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- West Peoria, IL
- NPI 1487678934
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1073625679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 N WESTERN AVE",
"city": "WEST PEORIA",
"state": "IL",
"postal_code": "616045129",
"telephone_number": "309-676-4421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 N WESTERN AVE",
"city": "WEST PEORIA",
"state": "IL",
"postal_code": "616045129",
"telephone_number": "309-676-4421"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHARMAX INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "MCINTOSH",
"authorized_official_first_name": "LARRY",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "314-954-5510"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IL",
"license": "054014717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP #",
"identifier": "1426217",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "dba Pharmax Pharmacy #9907",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in West Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.