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General NPI Number Information
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NPI Number | 1073822326
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Entity Type | Organization
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Legal Business Name | NELSON DRUG STORE
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 918 N MAIN ST
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City | PRINCETON
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State | IL
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Zip | 61356-1335
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Country | US
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Telephone | 815-875-4415
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Fax | 815-875-4321
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Provider Business Mailing Address
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Address Line | 918 N MAIN ST
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City | PRINCETON
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State | IL
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Zip | 61356-1335
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Country | US
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Telephone | 815-875-4415
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Fax | 815-875-4321
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. WILLIAM EUGENE NELSON
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Credential | PHARMACIST
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Telephone | 815-875-4415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054000044
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License Number State | IL
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