Organization
SULLIVAN DRUGS OF STAUNTON
Active
Other names
SULLIVAN DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE SULLIVAN R.PH. (PRESIDENT)
(217) 839-2909
Entity
Organization
Contact information
Practice address
101 E MAIN ST, STAUNTON, IL 62088-1446
(618) 635-2595
(618) 635-5590
Mailing address
101 E MAIN ST, STAUNTON, IL 62088-1446
(618) 635-2595
(618) 635-5590
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054004541
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016642
PK
—
Enumeration date
12/12/2005
Last updated
06/09/2016
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