Mt Vernon Community Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054016737 Issued in IL

Legal business name

MT VERNON COMMUNITY PHARMACY INC

Doing business as

The Medicine Shoppe

Practice address

2339 Broadway St
Mount Vernon, IL 62864-2925

Phone

(618) 242-8776

NPI assigned

Feb 24, 2006

Last updated

Nov 1, 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

Eric BlackNPI 1598877961

Title

Owner

Phone

(618) 242-8776

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• The Medicine Shoppe Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

Tax ID family

Mt Vernon Comm Pharm Inc2 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.

• Mt Vernon Community Pharmacy Inc

  dba The Medicine Shoppe

  • Long Term Care Pharmacy
  • Mount Vernon, IL
  • NPI 1811543648
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Mt Vernon Community Pharmacy Inc

  dba The Medicine Shoppe

  • Long Term Care Pharmacy
  • Mount Vernon, IL
  • NPI 1811543648
  NPPES parent name

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.

• Eric Lee Black, R.PH

  • Pharmacist
  • Mount Vernon, IL
  • NPI 1598877961
  Authorized official Same address or phone

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1417923012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 BROADWAY ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642925",
            "telephone_number": "618-242-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 BROADWAY ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642925",
            "telephone_number": "618-242-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT VERNON COMMUNITY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-242-8776"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054016737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "334555",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4132021",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1447792",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mount Vernon Chiropractic Clinic
• Mount Vernon Emergency Group PC
• Mount Vernon Heart Institute LTD
• Mount Vernon Medical Enterprises Inc
• Kelli Mowrer, CNP
• Mt Vernon Community Pharmacy Inc (The Medicine Shoppe)
• Mt Vernon Cty SCH Dist 80
• Mt Vernon Family Practice PC
• Mt Vernon Neurology, S.C.
• Mt Vernon Radiation Therapy Center

• Community/Retail Pharmacy in Mount Vernon, IL
• Providers in Mount Vernon, 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 Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.