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General NPI Number Information
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NPI Number | 1174664395
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Entity Type | Organization
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Legal Business Name | MOLINE DRUG INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1610 15TH STREET PL
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City | MOLINE
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State | IL
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Zip | 61265-3959
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Country | US
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Telephone | 309-762-0971
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Fax | 309-762-4722
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Provider Business Mailing Address
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Address Line | 1610 15TH STREET PL
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City | MOLINE
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State | IL
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Zip | 61265-3959
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Country | US
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Telephone | 309-762-0971
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Fax | 309-762-4722
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT SUNNER
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Credential | RPH
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Telephone | 309-762-0971
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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 | 054.008409
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License Number State | IL
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