NPIMap

Organization Active NPI

Mt Vernon Community Pharmacy Inc

  • Long Term Care Pharmacy
  • Mount Vernon, IL
National Provider Identifier
1811543648
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MT VERNON COMMUNITY PHARMACY INC
Practice address
2339 Broadway St
Mount Vernon, IL 62864-2925
Phone
(618) 242-8776
Fax
(618) 244-9475
NPI assigned
Aug 16, 2019
Organization subpart
Yes
Parent organization
MT VERNON COMMUNITY PHARMACY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Authorized official

Name
Tracey Adams
Title
General Manager
Phone
(618) 242-8776

Specialties & licenses 1

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

Addresses

Primary practice location

2339 Broadway St
Mount Vernon, IL 62864-2925

Mailing address

2339 Broadway St
Mount Vernon, IL 62864-2925
Phone (618) 242-8776

Other names 1

  • The Medicine Shoppe Doing business as

National Provider Directory

National Provider Directory
Tax ID family
The Medicine Shoppe2 organizations share this tax ID, including this one
Part of
The Medicine Shoppe

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565913600000",
    "number": "1811543648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 BROADWAY ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642925",
            "telephone_number": "618-242-8776",
            "fax_number": "618-244-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 BROADWAY ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642925",
            "telephone_number": "618-242-8776",
            "fax_number": "618-244-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT VERNON COMMUNITY PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MT VERNON COMMUNITY PHARMACY INC",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "618-242-8776"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.