NPIMap

Organization Active NPI

Nauvoo Pharmacy, PLLC

  • Community/Retail Pharmacy
  • Nauvoo, IL
National Provider Identifier
1740914654
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
NAUVOO PHARMACY, PLLC
Practice address
1350 Mulholland St
Nauvoo, IL 62354-1010
Phone
(217) 453-2717
Fax
(217) 453-6456
NPI assigned
Jul 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mattie Ann Haas, PHARMDNPI 1235520644
Title
Pharmacist/Owner
Phone
(217) 453-2717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1350 Mulholland St
Nauvoo, IL 62354-1010

Mailing address

PO Box 248
Nauvoo, IL 62354-0248
Phone (217) 453-2717

Other names 1

  • Nauvoo Pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Nauvoo Pharmacy2 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.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1740914654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "NAUVOO",
            "state": "IL",
            "postal_code": "623540248",
            "telephone_number": "217-453-2717",
            "fax_number": "217-453-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 MULHOLLAND ST",
            "city": "NAUVOO",
            "state": "IL",
            "postal_code": "623541010",
            "telephone_number": "217-453-2717",
            "fax_number": "217-453-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAUVOO PHARMACY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-15",
        "last_updated": "2022-07-15",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "MATTIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "217-453-2717",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nauvoo Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Nauvoo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.