OrganizationActive
Southern Illinois University Student
NPI 1124064035 · Institutional Pharmacy · Carbondale, IL
Provider details
- NPI number
- 1124064035
- Entity type
- Organization
- Primary specialty
- Institutional PharmacySuppliers
- Authorized official
- Susan Chaney, Pharmacy Director
- License
- 054.017089 (IL)
Practice location
374 E Grand Ave
Carbondale, IL 62901-3962
Phone: (618) 453-4417
Fax: (618) 453-4672
Mailing address
374 E Grand Ave
Carbondale, IL 62901-3962
Registry dates
- Enumerated
- 2006-06-20
- Last updated
- 2016-04-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.