The Carbondale Clinic Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0054-009512 Issued in IL

Legal business name

THE CARBONDALE CLINIC PHARMACY

Practice address

2601 W Main St
Suite 101
Carbondale, IL 62901-1031

Phone

(618) 549-5361

Fax

(618) 549-5158

NPI assigned

Dec 28, 2006

Last updated

Apr 30, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

THE CARBONDALE CLINIC, S.C.As reported in NPPES

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

Authorized official

Name

Mr. Allan Norman

Title

Ceo

Phone

(618) 549-5361

Specialties & licenses 8

Addresses

Other identifiers 2

Part of

Carbondale Clinic

Locations

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1710043435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "address_2": "SUITE 101",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-549-5361",
            "fax_number": "618-549-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "address_2": "SUITE 101",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-549-5361",
            "fax_number": "618-549-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CARBONDALE CLINIC PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CARBONDALE CLINIC, S.C.",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-549-5361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051-034485",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051-023018",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049-083922",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049-127699",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049-173061",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049-156580",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049-169519",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "0054-009512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1454014",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "1296860001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Faith Taylor, LSW
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• Breanna Thomas
• Mike Thomas, PHARMACIST
• Myranda Nicole Thomas

• Community/Retail Pharmacy in Carbondale, IL
• Providers in Carbondale, 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 Apr 30, 2008; 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.