Healthcare Provider Details

I. General information

NPI: 1346895604
Provider Name (Legal Business Name): BODE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 1/2 N 1ST ST
VIENNA IL
62995-1849
US

IV. Provider business mailing address

803 1/2 N 1ST ST
VIENNA IL
62995-1849
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-3784
  • Fax: 618-658-4070
Mailing address:
  • Phone: 618-658-3784
  • Fax: 618-658-4070

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: CARL E BODE
Title or Position: PRESIDENT
Credential:
Phone: 618-748-9253