Provider Demographics
NPI:1568574911
Name:PRN PHARMACIES LTD
Entity type:Organization
Organization Name:PRN PHARMACIES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-252-5349
Mailing Address - Street 1:304 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2108
Mailing Address - Country:US
Mailing Address - Phone:618-252-5349
Mailing Address - Fax:618-252-1395
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:IL
Practice Address - Zip Code:62979-1210
Practice Address - Country:US
Practice Address - Phone:618-272-3841
Practice Address - Fax:618-272-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL203001134332B00000X
IL054.0166503336C0003X
IL0540157753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1426611OtherNCPDP
ILFM1462186OtherDEA
ILFM1462186OtherDEA
IL216223Medicare PIN
IL1426611OtherNCPDP