Healthcare Provider Details

I. General information

NPI: 1447354485
Provider Name (Legal Business Name): MORELAND & DEVITT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PITTSFIELD RD # B
MT STERLING IL
62353-1626
US

IV. Provider business mailing address

200 PITTSFIELD RD # B
MT STERLING IL
62353-1626
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-2144
  • Fax: 217-773-2832
Mailing address:
  • Phone: 217-773-2144
  • Fax: 217-773-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054018459
License Number StateIL

VIII. Authorized Official

Name: MR. SCOTT ALLEN STOLL
Title or Position: CHEIF OPERATIONS OFFICER
Credential:
Phone: 217-322-3333