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DOLAN CENTRAL ILLINOIS COMPOUNDING LLC NPI 1093883290


NPI Information

NPI: 1093883290
Provider Name: DOLAN CENTRAL ILLINOIS COMPOUNDING LLC

Doing Business As: PRECKSHOT PROFESSIONAL PHARMACY

Classification: Pharmacy - 3336C0004X
Entity Type: Organization

Specialization: Compounding Pharmacy

Address:
5832 N KNOXVILLE AVE STE E
PEORIA, IL
ZIP 61614
Phone: (309) 679-2047
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DOLAN CENTRAL ILLINOIS COMPOUNDING LLC is a compounding pharmacy pharmacy in Peoria, IL. The provider is a pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. DOLAN CENTRAL ILLINOIS COMPOUNDING LLC NPI is 1093883290. The provider is registered as an organization entity type.
The provider Is Doing Business As Preckshot Professional Pharmacy.

The provider's business location address is:

5832 N KNOXVILLE AVE STE E
PEORIA, IL
ZIP 61614-304
Phone: (309) 679-2047
Fax: (309) 679-2051

The provider's authorized official is Corey Dolan .
The authorized official title is Pharmacist and has the following contact phone number (309) 679-2047.

The enumeration date for this NPI number is 12/4/2006 and was last updated on 7/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacy054.020600ILLINOISNo
23336C0003XPharmacyCommunity/Retail Pharmacy2099-43WISCONSINNo
33336C0004XPharmacyCompounding Pharmacy4394IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12175601OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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