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General NPI Number Information
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NPI Number | 1437541869
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Entity Type | Organization
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Legal Business Name | DIVVYMED, LLC
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 4300 44TH AVE
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City | MOLINE
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State | IL
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Zip | 61265
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Country | US
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Telephone | 844-693-4889
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Fax | 855-587-7952
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Provider Business Mailing Address
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Address Line | 4300 44TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-6755
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Country | US
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Telephone | 844-693-4889
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Fax | 309-807-2462
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. KEVIN EUGENE BURR
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Credential |
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Telephone | 712-310-4701
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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