Provider Demographics
NPI:1174096028
Name:POLO PHARMACY, INC.
Entity type:Organization
Organization Name:POLO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-745-3700
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-0334
Mailing Address - Country:US
Mailing Address - Phone:779-226-1129
Mailing Address - Fax:779-226-1187
Practice Address - Street 1:111 E MASON ST
Practice Address - Street 2:
Practice Address - City:POLO
Practice Address - State:IL
Practice Address - Zip Code:61064-1521
Practice Address - Country:US
Practice Address - Phone:779-226-1129
Practice Address - Fax:779-226-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy