Healthcare Provider Details

I. General information

NPI: 1942388038
Provider Name (Legal Business Name): WARREN DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 EAST MAIN STREET
WARREN IL
61087
US

IV. Provider business mailing address

137 EAST MAIN STREET PO BOX 626
WARREN IL
61087
US

V. Phone/Fax

Practice location:
  • Phone: 815-745-3700
  • Fax: 815-745-3663
Mailing address:
  • Phone: 815-745-3700
  • Fax: 815-745-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KARRIE SABINSON
Title or Position: OWNER/PHARMD
Credential:
Phone: 815-745-3700