Provider Demographics
NPI:1679301733
Name:ATHENS PHARMACY
Entity type:Organization
Organization Name:ATHENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-553-2028
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:IL
Mailing Address - Zip Code:62613-0063
Mailing Address - Country:US
Mailing Address - Phone:217-636-3888
Mailing Address - Fax:
Practice Address - Street 1:202 N WEST ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:IL
Practice Address - Zip Code:62613-7665
Practice Address - Country:US
Practice Address - Phone:217-636-3888
Practice Address - Fax:217-636-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty