CRUSADER CLINIC PHARMACY (NPI# 1215086442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215086442 |
| Entity Type | Organization |
| Organization Name | CRUSADER CLINIC PHARMACY |
| Practice Address |
1100 Broadway Rockford IL 61104-1429 |
| Practice Telephone | 8154901600 |
| Mailing Telephone | 8154901600 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | PEGGY ANNE W DAVENPORT (EXECUTIVE ASSISTANT) |
| Authorized Official Telephone | 8154901601 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
========= | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE LICENSE | 054-14089 | 01 |
| IL | NABP | 1467580 | 01 |
| IL | STATE CS | 032-006837 | 01 |
| Street Address |
1100 BROADWAY |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-1429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952474256 | Catherine Louise Pieper | Pharmacist | 1100 Broadway, Rockford, IL 61104-1429 | 2006-11-16 |
| 1427601855 | Laboratory Corporation of America | Clinical Medical Laboratory | 1100 Broadway, Rockford, IL 61104-1429 | 2019-07-24 |
| 1871023341 | Theresa Marie Sheahan | Nurse Practitioner | 1100 Broadway, Rockford, IL 61104-1429 | 2017-06-15 |
| 1336455773 | Heather Moon Piper | Advanced Practice Midwife | 1100 Broadway, Rockford, IL 61104-1429 | 2010-08-23 |
| 1265601488 | Crusaders Central Clinic Association | Clinic/Center | 1100 Broadway, Rockford, IL 61104-1429 | 2008-02-21 |
| 1497953756 | Saleem Wong Siddiqui | Dentist | 1100 Broadway, Rockford, IL 61104-1429 | 2007-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| 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 |
|---|---|---|---|---|
| 1851440200 | Crusader West End Pharmacy | Pharmacy | 1200 W State St, Rockford, IL 61102-2112 | 2007-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447783915 | Bienestar Pharmacy IIi, Inc | Pharmacy | 2359 S Western Ave, Suite 100, Chicago, IL 60608-3837 | 2017-04-11 |
| 1851639371 | Health Delivery Management, LLC | Pharmacy | 430 Warrenville Road, Lisle, IL 60532 | 2013-01-17 |
| 1821239419 | Lehan Drugs Inc | Pharmacy | 1850 Gateway Dr. Suite A, Sycamore, IL 60178 | 2009-03-12 |
| 1760656987 | Mtm Services | Pharmacy | 1524 S Sangamon St Unit 512, Chicago, IL 60608-2268 | 2008-04-18 |
| 1023137528 | John H Stroger Jr. Hospital Pharmacy of Cook County | Pharmacy | 1901 W Harrison St Rm Ll170, Chicago, IL 60612-3714 | 2007-03-28 |
| 1588781298 | Cook County | Pharmacy | 500 E 51st Street, Room 2008 and 2050, Chicago, IL 60615 | 2007-03-26 |
| 1447390125 | Board of Trustees of The University of Illinois | Pharmacy | 722 W Maxwell St, Room 205 Mc 184, Chicago, IL 60607-5002 | 2007-02-08 |
| 1982791240 | Weber Medical Clinic Ltd | Pharmacy | 1200 N East Street, Olney, IL 62450-2499 | 2006-10-06 |
| 1093818148 | Altgeld Garden Drug Co. | Pharmacy | 974 E 133rd St, Chicago, IL 60827-1428 | 2006-09-06 |
| 1649270125 | American Pharmacy Inc | Pharmacy | 2200 W Roosevelt Rd, Broadview, IL 60155-3888 | 2005-07-27 |
| Find all providers with the same taxonomy | ||||
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| 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.