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Organization
MAURICE E SULLIVAN
Active
Organization
MAURICE E SULLIVAN
Active
Other names
SULLIVAN DRUG OF RAYMOND
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE SULLIVAN R.PH. (OWNER)
(217) 839-2909
Entity
Organization
Contact information
Practice address
801 N OBANNON ST, RAYMOND, IL 62560-5283
(217) 229-3022
(217) 229-3065
Mailing address
PO BOX 588, RAYMOND, IL 62560-0588
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054007502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018616
PK
—
05
—
323389477001
—
IL
Enumeration date
12/19/2005
Last updated
02/16/2017
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