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NPI 1124064035

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

More IL providers

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.

Southern Illinois University Student — NPI 1124064035, Carbondale, IL | NPI Central