Prairie Compounding Pharmacies Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054017639 Issued in IL

Legal business name

PRAIRIE COMPOUNDING PHARMACIES CORPORATION

Practice address

2801 N Main St
Decatur, IL 62526-3233

Phone

(217) 412-4408

Fax

(217) 875-2000

NPI assigned

Jan 25, 2011

Organization subpart

No

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

Authorized official

Name

Ann Rohde

Title

President

Phone

(217) 412-4408

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prairie Compounding Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1578868360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3798 E FULTON AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215053",
            "telephone_number": "217-876-7455",
            "fax_number": "217-875-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263233",
            "telephone_number": "217-412-4408",
            "fax_number": "217-875-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE COMPOUNDING PHARMACIES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-412-4408"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1485463",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Duane Potter, D.D.S.
• Sara Potter, RPH
• Hailey Powell
• Manjeshwar B. Prabhu, M.D.
• Practice Management Associates LLC
• Prairie Creek Village, LLC
• Prairie Emergency Physicians, LLP
• Prairie Eye Center, LTD
• Prairie Oncology Management Services Pharmacy
• Prairieland Service Coordination Inc

• Community/Retail Pharmacy in Decatur, IL
• Providers in Decatur, 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 Mar 24, 2011; 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.