Healthcare Provider Details

I. General information

NPI: 1154428720
Provider Name (Legal Business Name): HARTIG DRUG CO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
STOCKTON IL
61085-1321
US

IV. Provider business mailing address

703 MAIN ST
DUBUQUE IA
52001-6821
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-3411
  • Fax: 815-947-2837
Mailing address:
  • Phone: 563-588-8700
  • Fax: 563-588-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054014398
License Number StateIL

VIII. Authorized Official

Name: CHARLES S HARTIG
Title or Position: CEO
Credential: PHARMD, JD
Phone: 563-588-8700