| Organization Name: | PROPHARM RX INC |
| NPI Number: | 1306102728 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAURICE SULLIVAN (SEC/TRES) |
| Mailing Address: | 115 S Macoupin St Gillespie |
| State: | IL US |
| Postal Code: | 620331516 |
| Phone Number: | 2178393233 |
| Fax Number: | 2178393233 |
| NPI Enumeration Date: | 04/10/2012 |
| NPI Last Update Date: | 04/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |