Organization
MOWEAQUA PHARMACY PC
Active
Other names
MOWEAQUA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY TRASTER PHARMD (OWNER)
(217) 768-3832
Entity
Organization
Contact information
Practice address
620 N PUTNAM ST, MOWEAQUA, IL 62550-9482
(217) 768-3832
(217) 768-3077
Mailing address
620 N PUTNAM ST, MOWEAQUA, IL 62550-9482
(217) 768-3832
(217) 768-3077
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.014967
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017582
PK
—
Enumeration date
05/11/2006
Last updated
02/20/2017
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