Extended Living Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

054016055 Issued in IL

Legal business name

EXTENDED LIVING PHARMACY LLC

Practice address

338 W Marion Ave
Forsyth, IL 62535-1064

Phone

(217) 875-7147

Fax

(217) 875-7081

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey Aubry, RPH

Title

Manager

Phone

(217) 855-8378

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• EXTENDED LIVING PHARMACY LLC Doing business as

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1992899306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 W MARION AVE",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625351064",
            "telephone_number": "217-875-7147",
            "fax_number": "217-875-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 W MARION AVE",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625351064",
            "telephone_number": "217-875-7147",
            "fax_number": "217-875-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED LIVING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "AUBRY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-855-8378",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "054016055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2023265",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXTENDED LIVING PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EXTENDED LIVING PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Forsyth, IL
• Providers in Forsyth, IL by specialty
• Long Term Care Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.