Organization
K&S PHARMACIES OF SOUTHERN ILLINOIS LTD
Active
Other names
Moody Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAMUS NEAL KLOOS PHARMD (PHARMACIST IN CHARGE)
(618) 443-2715
Entity
Organization
Contact information
Practice address
109 E BROADWAY ST, SPARTA, IL 62286-1678
(618) 443-2715
(618) 443-6218
Mailing address
109 E BROADWAY ST, SPARTA, IL 62286-1678
(618) 443-2715
(618) 443-6218
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-015396
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1278769
—
LA
01
—
2016628
PK
—
Enumeration date
11/15/2006
Last updated
10/03/2018
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