# ERNEST & SUSAN L ROALES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SCOTTS DRUGS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346243672
- **Authorized official:** ERNEST ROALES RPH (OWNER)
- **Authorized official phone:** (618) 945-3701

## Contact information

- **Practice address:** 208 N MAIN ST, BRIDGEPORT, IL 62417-1522
- **Practice address phone:** (618) 945-3701
- **Practice address fax:** (618) 945-3701
- **Mailing address:** PO BOX 75, BRIDGEPORT, IL 62417-0075
- **Mailing address phone:** (618) 945-3701
- **Mailing address fax:** (618) 945-9382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054008755 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/31/2005
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018808 | PK | — |