Dolan Central Illinois Compounding Pharmacy LLC

Primary specialty

PharmacistTaxonomy code 183500000X

Legal business name

DOLAN CENTRAL ILLINOIS COMPOUNDING PHARMACY LLC

Practice address

5832 N Knoxville Ave Ste E
Peoria, IL 61614-4304

Phone

(309) 679-2047

Fax

(309) 679-2051

NPI assigned

Jan 12, 2018

Last updated

Mar 19, 2018By 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

Corey Dolan, PHARM D

Title

Owner/Pharmacy Manager

Phone

(309) 679-2047

Specialties & licenses 1

Addresses

Tax ID family

Dolan Central Illinois Compounding LLC2 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.

• Dolan Central Illinois Compounding LLC

  dba Preckshot Professional Pharmacy

  • Compounding Pharmacy
  • Peoria, IL
  • NPI 1093883290
  NPD tax ID

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521417600000",
    "number": "1568970556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5832 N KNOXVILLE AVE STE E",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144304",
            "telephone_number": "309-679-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5832 N KNOXVILLE AVE STE E",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144304",
            "telephone_number": "309-679-2047",
            "fax_number": "309-679-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOLAN CENTRAL ILLINOIS COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-03-19",
        "status": "A",
        "authorized_official_last_name": "DOLAN",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "OWNER/PHARMACY MANAGER",
        "authorized_official_telephone_number": "309-679-2047",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Rae Dodd, L.C.S.W.
• Jenny R. Doering
• Morgan Doerr
• Paige Doherty
• Dolan Central Illinois Compounding LLC (Preckshot Professional Pharmacy)
• Shannon Dolan
• Tonia Dolan
• Pamela Doloszycki, APN
• Cassidy Louise Domagalla
• Matthew David Domico, MSW, LCSW

• Pharmacist in Peoria, IL
• Providers in Peoria, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.