Organization
RENES DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GORDON JOHN MAZZOTTI LICENSED REGISTERED (PRESIDENT CHIEF EXECUTIVE OFFICER)
(217) 824-3533
Entity
Organization
Contact information
Practice address
201 WEST MAIN CROSS, TAYLORVILLE, IL 62568-2247
(217) 824-3533
(217) 824-3492
Mailing address
201 WEST MAIN CROSS, TAYLORVILLE, IL 62568-2247
(217) 824-3533
(217) 824-3492
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054005099
IL
Other
Enumeration date
12/04/2006
Last updated
12/14/2010
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