1386717502 NPI number — MOORE FAMILY STORES INC.

Table of content: (NPI 1386717502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386717502 NPI number — MOORE FAMILY STORES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOORE FAMILY STORES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROWNS DRUG STORE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386717502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 W JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EFFINGHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62401-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-342-2185
Provider Business Mailing Address Fax Number:
217-342-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-342-2185
Provider Business Practice Location Address Fax Number:
217-342-7069
Provider Enumeration Date:
11/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
TRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
217-362-6226

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  054020328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 054016709 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1386717502 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1463708 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16103882 . This is a "STATE TAX ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".