NPIMap

Organization Active NPI

Illinois Department of Human

  • Long Term Care Pharmacy
  • Kankakee, IL
National Provider Identifier
1528111424
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
054.020222 Issued in IL
Legal business name
ILLINOIS DEPARTMENT OF HUMAN
Practice address
100 E Jeffery St
Kankakee, IL 60901-5018
Phone
(815) 939-8272
Fax
(815) 939-8274
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Ronda Ann Sumner, RPH
Title
Pharmacy Manager
Phone
(815) 939-8272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 054.020222 IL Primary

Addresses

Primary practice location

100 E Jeffery St
Kankakee, IL 60901-5018

Mailing address

100 E Jeffery St
Kankakee, IL 60901-5018
Phone (815) 939-8272

Other identifiers 1

IdentifierTypeStateIssuer
2023336OtherPK

Other names 1

  • Shapiro Developmental Center Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Howe Center - Unit 4264292 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1528111424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E JEFFERY ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609015018",
            "telephone_number": "815-939-8272",
            "fax_number": "815-939-8274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E JEFFERY ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609015018",
            "telephone_number": "815-939-8272",
            "fax_number": "815-939-8274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "SUMNER",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "815-939-8272",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "054.020222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2023336",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shapiro Developmental Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.