NPIMap

Organization Active NPI

11 South Medical Pharmacy, LLC

  • Pharmacy
  • Columbia, IL
National Provider Identifier
1194247080
Registry record updated Jul 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
054020346 Issued in IL
Legal business name
11 SOUTH MEDICAL PHARMACY, LLC
Practice address
1000 Eleven South
Ste 2B
Columbia, IL 62236
Phone
(618) 281-3500
NPI assigned
Jul 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Authorized official

Name
Kelsie Lider, PHARMD
Title
Pharmacy Manager
Phone
(618) 281-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 054020346 IL Primary

Addresses

Primary practice location

1000 Eleven South
Ste 2B
Columbia, IL 62236

Mailing address

1000 Eleven S Ste 2B
Columbia, IL 62236-1079
Phone (618) 281-3500

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1194247080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ELEVEN S STE 2B",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622361079",
            "telephone_number": "618-281-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ELEVEN SOUTH",
            "address_2": "STE 2B",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "62236",
            "telephone_number": "618-281-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "11 SOUTH MEDICAL PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "LIDER",
        "authorized_official_first_name": "KELSIE",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "618-281-3500",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054020346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2017; 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.