1588749584 NPI number — DOCS DRUGS LTD

Table of content: (NPI 1588749584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588749584 NPI number — DOCS DRUGS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCS DRUGS LTD
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:
DOC'S DRUGS MONEE
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:
1588749584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 E REED ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAIDWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60408-2090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-458-6104
Provider Business Mailing Address Fax Number:
815-458-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25624 S GOVERNORS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60449-8987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-534-8540
Provider Business Practice Location Address Fax Number:
708-534-2045
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
815-458-6104

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  20300759 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054-015736 , 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: 054-015736 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".