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NPI Code Detail

MEDICARE: BODE DRUG, INC

MEDICARE: BODE DRUG, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy54-11999IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11446625OTHERILNABP

General Provider Information

NPI Number : 1093895484
Entity Type Code : Organization
Provider Name (Legal Business Name) : BODE DRUG, INC
Provider Business Mailing Address
First Line : 1201 WASHINGTON AVE
Second Line :
City : CAIRO
State : IL
Zip : 62914-1808
Country : US
Telephone Number : 618-734-4321
Fax Number : 618-734-4525
Provider Business Practice Location Address
First Line : 1201 WASHINGTON AVE
Second Line :
City : CAIRO
State : IL
Zip : 62914-1808
Country : US
Telephone Number : 618-734-4321
Fax Number : 618-734-4525
Authorized Official
Title or Position : PRESIDENT
Name : MR. CARL E BODE
Credential : RPH
Telephone Number : 618-734-4321
Provider Enumeration Date : 10/17/2006
Last Update Date : 04/20/2008

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