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Organization
MCHUGH DRUG STORE LLC
Active
Organization
MCHUGH DRUG STORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM KOLTA (OWNER)
(561) 231-0939
Entity
Organization
Contact information
Practice address
70 SOUTH MADISON ST, CARTHAGE, IL 62321
(217) 257-2623
(217) 357-9515
Mailing address
70 S MADISON ST, CARTHAGE, IL 62321-1331
(217) 357-2623
(217) 357-9515
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054020158
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364126894001
—
IL
Enumeration date
11/28/2006
Last updated
08/16/2018
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