NPIMap

Organization Active NPI

Harrys Pharmacy Inc

Doing business as Carroll Street Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Pawnee, IL
National Provider Identifier
1376860254
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-17453 Issued in IL
Legal business name
HARRYS PHARMACY INC
Doing business as
Carroll Street Pharmacy, Inc.
Practice address
707 Carroll St Ste B
Pawnee, IL 62558-9661
Phone
(217) 627-7000
Fax
(217) 438-3447
NPI assigned
Apr 30, 2010
Last updated
Jul 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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

Authorized official

Name
Scott Borntreger, RPHNPI 1003418971
Title
Vice-President
Phone
(217) 627-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054-17453 IL Primary

Addresses

Primary practice location

707 Carroll St Ste B
Pawnee, IL 62558-9661

Mailing address

620 E Jackson St
Auburn, IL 62615-9784
Phone (217) 438-6141

Other identifiers 1

IdentifierTypeStateIssuer
1484310OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Carroll Street Pharmacy, Inc. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carroll Street Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

707 Carroll St
Ste B
Pawnee, IL 62558
Phone (217) 627-7000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1376860254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 E JACKSON ST",
            "city": "AUBURN",
            "state": "IL",
            "postal_code": "626159784",
            "telephone_number": "217-438-6141",
            "fax_number": "217-438-3447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 CARROLL ST STE B",
            "city": "PAWNEE",
            "state": "IL",
            "postal_code": "625589661",
            "telephone_number": "217-627-7000",
            "fax_number": "217-438-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRYS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "BORNTREGER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "217-627-7000",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-17453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1484310",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carroll Street Pharmacy, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pawnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; 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.