Okawville Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054011091 Issued in IL

Legal business name

OKAWVILLE PHARMACY

Doing business as

Okawville Pharmacy

Practice address

403 N Hanover
Okawville, IL 62271

Phone

(618) 243-6228

Fax

(618) 243-5608

NPI assigned

Oct 10, 2006

Last updated

Jun 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tim Rallo, RPH

Title

President

Phone

(618) 243-6228

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• OKAWVILLE PHARMACY Doing business as

Tax ID family

Okawville Pharmacy2 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.

• Tmrdlr LLC

  dba Okawville Pharmacy

  • Community/Retail Pharmacy
  • Okawville, IL
  • NPI 1073819496
  NPD tax ID

Locations

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1174610026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N HANOVER",
            "address_2": "P.O. BOX 424",
            "city": "OKAWVILLE",
            "state": "IL",
            "postal_code": "62271",
            "telephone_number": "618-243-6228",
            "fax_number": "628-243-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N HANOVER",
            "city": "OKAWVILLE",
            "state": "IL",
            "postal_code": "62271",
            "telephone_number": "618-243-6228",
            "fax_number": "618-243-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKAWVILLE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "RALLO",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-243-6228",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054011091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371134674001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1485374",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1438680",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OKAWVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Comwell (Human Service Center of S Metro E)
• Crossroads Physician Corporation (Crossroads Family Medicine of Okawville)
• H&S Pharmacies, LLC (Okawville Medicenter Pharmacy)
• Shannon Catherine Maberry, D.C.
• Okawville Family Care LLC
• PC Associates LLC
• Rachel Shubert, LCPC
• Tmrdlr LLC (Okawville Pharmacy)
• West Washington Co Cu Dist 10
• Zachary Yehling

• Community/Retail Pharmacy in Okawville, IL
• Providers in Okawville, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.