Provider Demographics
NPI:1548394851
Name:MEIJER PHARMACY 146
Entity type:Organization
Organization Name:MEIJER PHARMACY 146
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:217-353-4033
Mailing Address - Street 1:2401 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1233
Mailing Address - Country:US
Mailing Address - Phone:217-353-4033
Mailing Address - Fax:217-353-4065
Practice Address - Street 1:2401 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1233
Practice Address - Country:US
Practice Address - Phone:217-353-4033
Practice Address - Fax:217-353-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid