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General NPI Number Information
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NPI Number | 1437147246
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Entity Type | Organization
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Legal Business Name | BYRD-WATSON SOUTH 9TH DRUG CO
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1200 MAIN ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-3821
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Country | US
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Telephone | 618-242-2800
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Fax | 618-244-4816
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Provider Business Mailing Address
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Address Line | PO BOX 1179
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City | MOUNT VERNON
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State | IL
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Zip | 62864-0024
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Country | US
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Telephone | 618-242-2800
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Fax | 618-242-6775
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Authorized Official
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Title or Position | OFFICER OF THE CORPORATION
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Name | ADAM BREEZE
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Credential |
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Telephone | 618-244-5400
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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 | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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