Healthcare Provider Details

I. General information

NPI: 1730283789
Provider Name (Legal Business Name): MULCONREYS APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W 3RD ST
BEARDSTOWN IL
62618-1142
US

IV. Provider business mailing address

PO BOX 11
BEARDSTOWN IL
62618-0011
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-4422
  • Fax: 217-323-4480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MARK MULCONREY
Title or Position: OWNER
Credential:
Phone: 217-323-4422