Healthcare Provider Details

I. General information

NPI: 1235249756
Provider Name (Legal Business Name): MORELAND AND DEVITT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N CONGRESS ST
RUSHVILLE IL
62681-1434
US

IV. Provider business mailing address

124 N CONGRESS ST PO BOX 319
RUSHVILLE IL
62681-1434
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-3333
  • Fax: 217-322-6817
Mailing address:
  • Phone: 217-322-3333
  • Fax: 217-322-6817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54007553
License Number StateIL

VIII. Authorized Official

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