PETERSBURG PHARMACY, INC
NPI 1538259403
Pharmacy - Community/Retail Pharmacy in Petersburg, IL

Q: What is Petersburg Pharmacy, Inc's NPI number?

The NPI number for Petersburg Pharmacy, Inc is 1538259403. It was assigned to this organization in the NPPES registry on October 13, 2006.

Q: What is Petersburg Pharmacy, Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since October 13, 2006CLIA Certified · 2 labs

1 CENTRE DR, SUITE 100, PETERSBURG, IL 62675(217) 632-7777(217) 632-7618 Get Directions Write a Review

NPPES record last updated: June 2, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Petersburg Pharmacy, Inc NPPES

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

PETERSBURG PHARMACY, INC (NPI 1538259403) is a healthcare organization registered as a community/retail pharmacy in Petersburg, Illinois and active in the NPI registry since October 2006. The organization holds 2 active CLIA laboratory certificates and lists David Bagot, Pharmacist/owner, as its authorized official.

NPPES Registry Identity

NPI1538259403

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NamePETERSBURG PHARMACY, INC

Location Address1 CENTRE DR, SUITE 100Petersburg, IL 62675-9467

Mailing Address1 Centre Dr, Suite 100Petersburg, IL 62675-9467 · (217) 632-7777 · Fax (217) 632-7618

Phone(217) 632-7777

Fax(217) 632-7618

Organization SubpartNo

Authorized OfficialDavid BagotPharmacist/owner · (217) 632-7777

Enumeration DateOctober 13, 2006

Last NPPES UpdateJune 2, 2015

✔ NPI 1538259403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in IL · 054.015430

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.

1 CENTRE DR, Petersburg, IL 62675

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Other Identifiers 7

Other3574-5932IL · State Id Number

Other054.015430IL · Div 1 Pharmacy License

Medicaid=========001IL

Other120007769IL · Medco Provider Number

Other1477745IL · Nabp Number

Other320.008365IL · Controlled Sub Lic #

Medicare ID-Type Unspecified5385570001IL · Medicare Provider Number

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2202682

Petersburg Pharmacy · Petersburg, IL

Active · expires Nov 29, 2026

CLIA Number14D2202682

Laboratory TypePharmacy

Certificate Effective DateNovember 30, 2024

Certificate Expiration DateNovember 29, 2026

Laboratory DirectorDavid M. Bagot

Laboratory Phone(217) 632-7777

Laboratory LocationPetersburg Pharmacy1 Centre Drive Ste 100, Petersburg, IL 62675

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D0878837

M P S - Petersburg · Petersburg, IL

Active · expires May 23, 2027

CLIA Number14D0878837

Laboratory TypePhysician Office

Certificate Effective DateMay 24, 2025

Certificate Expiration DateMay 23, 2027

Laboratory DirectorJoe Bilyeu

Laboratory Phone(217) 632-7761

Laboratory LocationM P S - Petersburg1 Centre Drive, Petersburg, IL 62675

CLIA data matches this NPI record on: Address

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

102 services99 patients

Influenza vaccine, inactivated 90653

The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.

92 services92 patients

Medical Equipment Supplier Medicare DMEPOS 2

Medicare supplier enrollment and the product categories Petersburg Pharmacy carries, from the Medicare DMEPOS supplier directory.

Petersburg Pharmacy

DMEPOS supplier · Petersburg, ILOperated by Petersburg Pharmacy Inc

✔

Accepts Medicare assignment

Petersburg Pharmacy agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20453645

Medicare Participant SinceSeptember 1, 2018

Supplier Location1 Centre Dr Ste 100Petersburg, IL 62675

Phone(217) 632-7777

Supplier Specialties

Pharmacy

Medicare Product Categories

Blood Glucose Monitors/Supplies (Non-Mail Order)

Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device

Orthoses: Off-The-Shelf

Met pads, Heel pads, Heel spur pads

Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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Other Providers at the Same Location NPPES 14

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

JOE A BILYEU M.D.

Family Medicine