Healthcare Provider Details

I. General information

NPI: 1740264340
Provider Name (Legal Business Name): DOT DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 JUBILEE LN
METAMORA IL
61548-8472
US

IV. Provider business mailing address

505 JUBILEE LN
METAMORA IL
61548-8472
US

V. Phone/Fax

Practice location:
  • Phone: 309-383-3000
  • Fax: 309-383-3048
Mailing address:
  • Phone: 309-383-3000
  • Fax: 309-383-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054014334
License Number StateIL

VIII. Authorized Official

Name: MR. MARLIN WEEKLEY
Title or Position: OWNER
Credential:
Phone: 309-383-3000