Organization
THROGMORTON POWLESS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOB POWLESS (OWNER)
(618) 662-2174
Entity
Organization
Contact information
Practice address
123 E NORTH AVE, FLORA, IL 62839-2028
(618) 662-2174
(618) 662-9442
Mailing address
PO BOX 577, FLORA, IL 62839-0577
(618) 662-2174
(618) 662-9442
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370627101001
—
IL
Enumeration date
01/31/2007
Last updated
08/22/2020
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