Organization
K&S PHARMACIES OF SOUTHERN ILLINOIS LTD
Active
Other names
Moody Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAMUS N KLOOS PHARM.D. (CORP TREASURER/PHARMACIST IN CHARGE)
(618) 443-2715
Entity
Organization
Contact information
Practice address
157 W BROADWAY ST, SPARTA, IL 62286-1619
(618) 443-2715
(618) 443-6218
Mailing address
157 W BROADWAY ST, SPARTA, IL 62286-1619
(618) 443-2715
(618) 443-6218
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054015396
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032008353
STATE CONTROLLED SUBSTANE
IL
01
—
054015396
STATE LICENSE NUMBER
IL
01
—
1427310
NCPDP NUMBER
—
Enumeration date
09/06/2005
Last updated
10/03/2018
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