11 South Medical Pharmacy, LLC

NPI #1194247080 in Columbia, Illinois

Provider Information

NPI Number: 1194247080
Entity Type: Organization
Organization Name: 11 South Medical Pharmacy, LLC
Primary Specialty: Pharmacy
Enumeration Date: Jul 12, 2017
Last Updated: Jul 28, 2017

Practice Location

Address: 1000 ELEVEN SOUTH
Address 2: STE 2B
City: Columbia
State: Illinois
ZIP Code: 62236
Phone: (618) 281-3500

Authorized Official

Name: KELSIE LIDER, PHARMD
Title: PHARMACY MANAGER
Phone: (618) 281-3500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacy	333600000X	Primary

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