Active NPI
John's Pharmacy Inc
Doing business as The Sullivan Pharmacy LTC
- Long Term Care Pharmacy
- Sullivan, IL
National Provider Identifier
1306508890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- JOHN'S PHARMACY INC
- Doing business as
- The Sullivan Pharmacy LTC
- Practice address
- 102 E Harrison St
Sullivan, IL 61951-2002 - Phone
- (217) 728-2331
- Fax
- (217) 728-2223
- NPI assigned
- Oct 12, 2021
- Last updated
- Oct 12, 2021
- Organization subpart
- Yes
- Parent organization
- JOHN'S PHARMACY INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tony L Jones, RPH
- Title
- President/Pharmacist
- Phone
- (217) 728-2331
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
102 E Harrison St
Sullivan, IL 61951-2002
Mailing address
102 E Harrison St
Sullivan, IL 61951-2002
Phone (217) 728-2331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932208907 | Medicaid | IL |
Other names 1
- The Sullivan Pharmacy LTC
National Provider Directory
National Provider Directory- Part of
- John's Pharmacy Inc
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633996800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1633996800000",
"number": "1306508890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 E HARRISON ST",
"city": "SULLIVAN",
"state": "IL",
"postal_code": "619512002",
"telephone_number": "217-728-2331",
"fax_number": "217-728-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 E HARRISON ST",
"city": "SULLIVAN",
"state": "IL",
"postal_code": "619512002",
"telephone_number": "217-728-2331",
"fax_number": "217-728-2223"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOHN'S PHARMACY INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "JOHN'S PHARMACY INC",
"enumeration_date": "2021-10-12",
"last_updated": "2021-10-12",
"certification_date": "2021-10-12",
"status": "A",
"authorized_official_last_name": "JONES",
"authorized_official_first_name": "TONY",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
"authorized_official_telephone_number": "217-728-2331",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1932208907",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Sullivan Pharmacy LTC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sullivan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.