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SOUTHERN ILLINOIS UNIVERSITY STUDENT
NPI 1124064035
Pharmacy - Institutional Pharmacy in Carbondale, IL

Active since June 20, 2006
374 E GRAND AVE, CARBONDALE, IL 62901(618) 453-4417(618) 453-4672 Get Directions Write a Review

NPPES record last updated: April 11, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southern Illinois University Student NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN ILLINOIS UNIVERSITY STUDENT (NPI 1124064035) is a healthcare organization registered as an institutional pharmacy in Carbondale, Illinois and active in the NPI registry since June 2006. The organization lists Susan Chaney, Pharmacy Director, as its authorized official.

NPPES Registry Identity

NPI1124064035
Entity TypeOrganization
Primary Taxonomy3336I0012X
Legal Business NameSOUTHERN ILLINOIS UNIVERSITY STUDENT
Location Address374 E GRAND AVECarbondale, IL 62901-3962
Mailing Address374 E Grand AveCarbondale, IL 62901-3962 · (618) 453-4417 · Fax (618) 453-4672
Phone(618) 453-4417
Fax(618) 453-4672
Organization SubpartNo
Authorized OfficialSusan ChaneyPharmacy Director · (618) 453-4417
Enumeration DateJune 20, 2006
Last NPPES UpdateApril 11, 2016
✔ NPI 1124064035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Institutional PharmacySuppliers
Taxonomy Code3336I0012X
License✔ Licensed in IL · 054.017089
Definition
A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; 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.
374 E GRAND AVE, Carbondale, IL 62901
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Other Names 1

Doing Business AsSouthern Illinois University Student

Other Identifiers 1

Other2016773Pk

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. WARREN THOMAS BUSH PH.D.
Psychologist (Clinical)
374 E GRAND AVE
CARBONDALE, IL 62901
Jackson County (618) 453-5371
MS. NANCY ANN MCDONALD PAC
Physician Assistant
374 E GRAND AVE, STUDENT HEALTH CENTER MAILCODE 6740
CARBONDALE, IL 62901
Jackson County (618) 453-3311
LYDIA KIM
Social Worker (Clinical)
374 E GRAND AVE
CARBONDALE, IL 62901
Jackson County (618) 452-3311
JILL BETHANY WILSON FNP
Nurse Practitioner
374 E GRAND AVE
CARBONDALE, IL 62901
Jackson County (618) 453-3311
DAMILOLA ROTIMI
Case Manager/Care Coordinator
374 E GRAND AVE
CARBONDALE, IL 62901
Jackson County (618) 901-6841
DR. KENDALL MARIE WACHTER DMD
Dentist (General Practice)
374 E GRAND AVE, STUDENT HEALTH CENTER SIUC
CARBONDALE, IL 62901
Jackson County (618) 536-2421
RUSSELL EDWARD KLEIN DMD
Dentist (General Practice)
374 E GRAND AVE, STUDENT HEALTH CENTER SIVC
CARBONDALE, IL 62901
Jackson County (618) 536-2421
PAUL ERIC WINCHESTER PTA
Physical Therapy Assistant
374 E GRAND AVE
CARBONDALE, IL 62901
Jackson County (618) 453-1292

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Illinois University Student's NPI number?

The NPI number for Southern Illinois University Student is 1124064035. It was assigned to this organization in the NPPES registry on June 20, 2006.

Where is Southern Illinois University Student located?

Southern Illinois University Student is located at 374 E Grand Ave, Carbondale, IL 62901. The listed phone number is (618) 453-4417.

What is Southern Illinois University Student's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Institutional Pharmacy, with taxonomy code 3336I0012X.

When was this NPI record last updated?

The NPPES record for Southern Illinois University Student was last updated on April 11, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.