EXTENDED LIVING PHARMACY LLC (NPI# 1992899306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992899306 |
| Entity Type | Organization |
| Organization Name | EXTENDED LIVING PHARMACY LLC |
| Other Organization Name | EXTENDED LIVING PHARMACY LLC |
| Practice Address |
338 W Marion Ave Forsyth IL 62535-1064 |
| Practice Telephone | 2178757147 |
| Practice Fax Number | 2178757081 |
| Mailing Telephone | 2178757147 |
| Mailing Fax Number | 2178757081 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-03-13 |
| Authorized Official Name | JEFFREY AUBRY (MANAGER) |
| Authorized Official Telephone | 2178558378 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
054016055 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2023265 | 01 |
| Other Name | Type Code |
|---|---|
| EXTENDED LIVING PHARMACY LLC | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | EXTENDED LIVING PHARMACY LLC | 2459 E Federal Drive, Decatur, Il 62526 |
| Street Address |
338 W MARION AVE |
| City | FORSYTH |
| State | IL |
| Zip Code | 62535-1064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265787998 | Anisha Jacob | Optometrist | 106 East Barnett Ave, Forsyth, IL 62535 | 2012-07-18 |
| 1376821017 | Aashay Shah | Optometrist | 106 E Barnett Ave, Forsyth, IL 62535 | 2011-07-29 |
| 1730490616 | Travis R. Jameson | Internal Medicine | 241 West Weaver Rd, Suite 210, Forsyth, IL 62535 | 2010-06-25 |
| 1285869131 | Eyemart Express, Ltd | Durable Medical Equipment & Medical Supplies | 849 Us Hwy 51 South, Suite B, Forsyth, IL 62535 | 2009-05-21 |
| 1629246509 | Healthy Soles Inc | Homeopath | 332 W Marion, Suite 2, Forsyth, IL 62535 | 2008-02-13 |
| 1861503864 | David Nickolas Weis | Psychologist | 133 E Cox St, Forsyth, IL 62535 | 2006-08-31 |
| 1811486350 | Stephanie Sueann Stivers | Nurse Practitioner | 845 S Route 51, Forsyth, IL 62535 | 2018-05-09 |
| 1841799848 | Casey Christopher Vercruysse | Physician Assistant | 845 S Route 51, Forsyth, IL 62535 | 2018-02-05 |
| 1114234085 | Brittney L Moutray | Dietitian, Registered | 241 W Weaver Rd, Suite 210, Forsyth, IL 62535 | 2010-09-13 |
| 1558469155 | Sunni Leigh Delahunty | Physician Assistant | 241 W Weaver Rd, Suite 145c, Forsyth, IL 62535 | 2006-09-20 |
| Find all providers in zip 62535 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| 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 |
|---|---|---|---|---|
| 1265863468 | Lake of Decatur, Inc | Pharmacy | 845 S Route 51, Unit B, Forsyth, IL 62535-9759 | 2013-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912512989 | Millenium Pharmacy Ltd | Pharmacy | 10604 Southwest Hwy Ste 102, Chicago Ridge, IL 60415-2704 | 2020-09-15 |
| 1992265235 | Illini Clinic Pharmacy Inc | Pharmacy | 211 S 1st Street, Alpha, IL 61413 | 2019-03-22 |
| 1750841342 | Illini Clinic Pharmacy Inc | Pharmacy | 855 Illini Dr Ste 200, Silvis, IL 61282-2904 | 2019-03-21 |
| 1679039358 | Remedi Seniorcare of Chicago, LLC | Pharmacy | 3600 Lacey Road, Suite 500, Downers Grove, IL 60515 | 2019-02-18 |
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1538672449 | Wear Ltc | Pharmacy | 527 N Madison St Ste B, Carthage, IL 62321-1034 | 2017-11-14 |
| 1124546031 | Symbria Rx Services, LLC. | Pharmacy | 3200 Grant St Rm 41, Evanston, IL 60201-1903 | 2017-08-31 |
| 1699146720 | Pharmblue Illinois LLC | Pharmacy | 2960 Chartres St Ste 100, La Salle, IL 61301-1097 | 2015-10-15 |
| 1194144691 | Lifemed Illinois, LLC | Pharmacy | 881 Il Route 83, Bensenville, IL 60106-1219 | 2014-04-11 |
| 1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
| 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.