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Lake Of Decatur Inc
Managed Care Organization Pharmacy in Decatur, Illinois
NPI 1588613384

Lake Of Decatur Inc is a Managed Care Organization Pharmacy based in Decatur, IL and is specialized in Managed Care Organization Pharmacy. Lake Of Decatur Inc practices in Decatur, IL. The NPI Number for Lake Of Decatur Inc is 1588613384 and holds a License No. (Illinois).

The current practice location address for Lake Of Decatur Inc is 245 W 1St Dr Ste B, Decatur, IL and can be reached out via phone at 217-429-5165 and via fax at 217-429-5172.

Location: 245 W 1St Dr Ste B, Decatur, IL, 62521-5381
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1588613384
Provider Name
Lake Of Decatur Inc
Credential
Provider Entity Type
Organization
Address
245 W 1St Dr Ste B, Decatur, IL, 62521-5381
Phone Number
217-429-5165
Fax Number
217-429-5172
Provider Enumeration Date
05/09/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2021672 01 PK
institution
Provider Business Practice Location Address Details
Address
245 W 1St Dr Ste B
City
Decatur
State
Illinois
Zip
62521-5381
Phone Number
217-429-5165
Fax Number
217-429-5172
person
Provider Business Mailing Address Details
Address
245 W 1St Dr Ste B
City
Decatur
State
Illinois
Zip
62521-5381
Phone Number
217-429-5165
Fax Number
217-429-5172
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Pharmacy
Speciality
-
Taxonomy
333600000X
License No.
()
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Pharmacy
Speciality
Community/Retail Pharmacy
Taxonomy
3336C0003X
License No.
()
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); 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.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Pharmacy
Speciality
Long Term Care Pharmacy
Taxonomy
3336L0003X
License No.
54.015385 (Illinois)
Definition
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.
person
Provider's Taxonomy Details 4
Type
Suppliers
Classification
Pharmacy
Speciality
Managed Care Organization Pharmacy
Taxonomy
3336M0003X
License No.
()
Definition
A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.
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