# BYRD-WATSON TIMES SQUARE DRUG CO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Byrd-Watson Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598775413
- **Authorized official:** ADAM BREEZE (OFFICER OF THE CORPORATION)
- **Authorized official phone:** (618) 244-5400

## Contact information

- **Practice address:** 3401 BROADWAY ST, MOUNT VERNON, IL 62864-2201
- **Practice address phone:** (618) 244-5400
- **Practice address fax:** (618) 244-5988
- **Mailing address:** PO BOX 1179, MOUNT VERNON, IL 62864-0024
- **Mailing address phone:** (618) 244-5400
- **Mailing address fax:** (618) 244-5409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 054009959 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | 054.009959 | IL | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 04/08/2025