Healthcare Provider Details

I. General information

NPI: 1447300926
Provider Name (Legal Business Name): CITY DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MAIN ST
WHITE HALL IL
62092-1054
US

IV. Provider business mailing address

116 N MAIN ST
WHITE HALL IL
62092-1054
US

V. Phone/Fax

Practice location:
  • Phone: 217-374-6712
  • Fax: 217-374-6405
Mailing address:
  • Phone: 217-374-6712
  • Fax: 217-374-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARY BREECE
Title or Position: PHARMACIST
Credential:
Phone: 217-374-6712