Healthcare Provider Details

I. General information

NPI: 1538084777
Provider Name (Legal Business Name): CAINS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 8TH ST
VANDALIA IL
62471-1028
US

IV. Provider business mailing address

1401 N 8TH ST
VANDALIA IL
62471-1028
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-0196
  • Fax: 618-283-9150
Mailing address:
  • Phone: 618-283-0196
  • Fax: 618-283-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DARRYL PAUL TJADEN
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 618-283-0196