1134671324 NPI number — MORELAND & DEVITT INC

Table of content: (NPI 1134671324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134671324 NPI number — MORELAND & DEVITT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORELAND & DEVITT 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:
MORELAND & DEVITT PHARMACY
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:
1134671324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62691-0041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-452-3301
Provider Business Mailing Address Fax Number:
217-452-7532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E BEARDSTOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62691-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-452-3301
Provider Business Practice Location Address Fax Number:
217-452-7532
Provider Enumeration Date:
11/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STOLL
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CHEIF OPERATIONS OFFICER
Authorized Official Telephone Number:
217-322-3333

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054.017557 , 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: 2165729 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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