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Organization
SULLIVAN DRUGS OF STAUNTON
Active
Organization
SULLIVAN DRUGS OF STAUNTON
Active
Other names
SULLIVAN DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE SULLIVAN R.PH. (PRESIDENT)
(217) 839-2909
Entity
Organization
Contact information
Practice address
101 E MAIN ST, STAUNTON, IL 62088-1446
(618) 635-2595
(618) 635-5590
Mailing address
101 E MAIN ST, STAUNTON, IL 62088-1446
(618) 635-2595
(618) 635-5590
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054004541
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016642
PK
—
Enumeration date
12/12/2005
Last updated
06/09/2016
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