Organization
MEDICINE SHOPPE OF DEKALB INC
Active
Other names
THE MEDICINE STOP
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TAMBLYN RPH (OWNER)
(515) 758-8995
Entity
Organization
Contact information
Practice address
810 S 4TH ST, DEKALB, IL 60115-4410
(815) 758-8995
(815) 748-3784
Mailing address
810 S 4TH ST, DEKALB, IL 60115-4410
(815) 758-8995
(815) 748-3784
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54010056
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1449429
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/17/2006
Last updated
03/03/2010
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