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General NPI Number Information
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NPI Number | 1235506106
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Entity Type | Organization
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Legal Business Name | M AND D PHARMACY, LLC.
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 201 S STATE ST
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City | BEARDSTOWN
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State | IL
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Zip | 62618-1219
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Country | US
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Telephone | 217-909-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S STATE ST
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City | BEARDSTOWN
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State | IL
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Zip | 62618-1219
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Country | US
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Telephone | 217-909-4330
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Fax |
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Authorized Official
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Title or Position | CHEIF OPERATIONS OFFICER
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Name | MR. SCOTT ALLEN STOLL
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Credential |
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Telephone | 217-322-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054019522
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License Number State | IL
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