NPIMap

Organization Active NPI

Lake of Decatur, Inc

Doing business as Colee's Corner Drugs

  • Community/Retail Pharmacy
  • Forsyth, IL
National Provider Identifier
1265863468
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-018441 Issued in IL
Legal business name
LAKE OF DECATUR, INC
Doing business as
Colee's Corner Drugs
Practice address
845 S Route 51
Unit B
Forsyth, IL 62535-9759
Phone
(217) 330-9552
Fax
(217) 791-6280
NPI assigned
Dec 12, 2013
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Dale Colee
Title
Owner
Phone
(217) 429-5165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054-018441 IL Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

845 S Route 51
Unit B
Forsyth, IL 62535-9759

Mailing address

845 S Route 51
Unit B
Forsyth, IL 62535-9759
Phone (217) 330-9552

Other names 1

  • Colee's Corner Drugs Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colee's Community 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.

Locations

845 S Route 51
Ste B
Forsyth, IL 62535
Phone (217) 330-9552

NPI Registry JSON

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1265863468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S ROUTE 51",
            "address_2": "UNIT B",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359759",
            "telephone_number": "217-330-9552",
            "fax_number": "217-791-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S ROUTE 51",
            "address_2": "UNIT B",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625359759",
            "telephone_number": "217-330-9552",
            "fax_number": "217-791-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OF DECATUR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-12",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "COLEE",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-429-5165"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-018441",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colee's Corner Drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colee's Corner Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forsyth, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.