SOUTHERN ILLINOIS UNIVERSITY STUDENT (NPI# 1124064035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124064035 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS UNIVERSITY STUDENT |
| Other Organization Name | SOUTHERN ILLINOIS UNIVERSITY STUDENT |
| Practice Address |
374 E Grand Ave Carbondale IL 62901-3962 |
| Practice Telephone | 6184534417 |
| Practice Fax Number | 6184534672 |
| Mailing Telephone | 6184534417 |
| Mailing Fax Number | 6184534672 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2016-04-11 |
| Authorized Official Name | SUSAN CHANEY (PHARMACY DIRECTOR) |
| Authorized Official Telephone | 6184534417 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
054.017089 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2016773 | 01 |
| Other Name | Type Code |
|---|---|
| SOUTHERN ILLINOIS UNIVERSITY STUDENT | Doing Business As Name - Organization |
| Street Address |
374 E GRAND AVE |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-3962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748635 | Warren Thomas Bush | Psychologist | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2020-04-14 |
| 1639715543 | Paul Eric Winchester | Physical Therapy Assistant | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2019-11-26 |
| 1952947004 | Jennifer Winchester | Physical Therapy Assistant | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2019-11-25 |
| 1992210975 | Alec Eshelman | Psychologist | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2017-12-12 |
| 1780133165 | Thomas Norbert Cerny | Pharmacist | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2016-09-27 |
| 1871834200 | Kyle Michael Chamness | Physical Therapy Assistant | 374 E Grand Ave, Carbondale, IL 62901-3962 | 2013-03-11 |
| 1780921312 | Christy L Hamilton | Counselor | 374 E Grand Ave, Mail Code 6740, Carbondale, IL 62901-3962 | 2013-01-16 |
| 1659617884 | Rosemary Elizabeth Simmons | Psychologist | 374 E Grand Ave, Counseling Center, Mail Code 4715, Siu, Carbondale, IL 62901-3962 | 2012-12-16 |
| 1639397128 | Russell Edward Klein | Dentist | 374 E Grand Ave, Student Health Center Sivc, Carbondale, IL 62901 | 2007-04-23 |
| 1629293709 | Kendall Marie Wachter | Dentist | 374 E Grand Ave, Student Health Center Siuc, Carbondale, IL 62901 | 2007-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 3336I0012X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Institutional Pharmacy |
| A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235525270 | Southern Illinois Hospital Services | Pharmacy | 405 W Jackson St, Carbondale, IL 62901-1462 | 2015-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689024036 | Forum Extended Care Services of Central Illinois | Pharmacy | 614 N 6th St Unit 200, Springfield, IL 62702-5313 | 2016-06-16 |
| 1730514944 | Rx Remote Solutions | Pharmacy | 1771 W Diehl Rd Ste 300, Naperville, IL 60563-4921 | 2013-09-06 |
| 1205854866 | Oak Forest Hospital Pharmacy | Pharmacy | 15900 Cicero Avenue, Oak Forest, IL 60452-4006 | 2006-07-18 |
| 1346592821 | Edward Hospital | Pharmacy | 801 S Washington St, Naperville, IL 60540 | 2012-10-09 |
| 1861648099 | Carle Foundation Hospital | Pharmacy | 1818 E Windsor Rd, Urbana, IL 61802-9566 | 2008-08-07 |
| 1285852772 | Carlinville Area Hospital Association | Pharmacy | 1001 Morgan St, Carlinville, IL 62626-1448 | 2007-04-23 |
| 1679616080 | Kiley Center | Pharmacy | 1401 W Dugdale Rd, Waukegan, IL 60085-6263 | 2007-02-15 |
| 1306987201 | Hammond Henry Hospital | Pharmacy | 600 N College Ave, Geneseo, IL 61254-1091 | 2007-02-12 |
| 1407901606 | Hillsboro Area Hospital, Inc. | Pharmacy | 1200 E Tremont St, Hillsboro, IL 62049-1912 | 2007-01-25 |
| 1205924024 | Mercer County Hospital Pharmacy | Pharmacy | 409 N.w. 9th Ave, Pharmacy, Aledo, IL 61231 | 2006-10-10 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on SOUTHERN ILLINOIS UNIVERSITY STUDENT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.