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General NPI Number Information
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NPI Number | 1558697326
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Entity Type | Organization
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Legal Business Name | FOOD STUFF, INC.
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 10338 N 1750 EAST RD
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City | BLOOMINGTON
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State | IL
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Zip | 61705-5950
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Country | US
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Telephone | 309-830-0711
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Fax | 866-592-3004
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Provider Business Mailing Address
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Address Line | 10338 N 1750 EAST RD
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City | BLOOMINGTON
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State | IL
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Zip | 61705-5950
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Country | US
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Telephone | 309-830-0711
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Fax | 866-592-3004
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JULIE R DOSTAL
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Credential | MS,RD,CDE
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Telephone | 309-830-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.001279
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License Number State | IL
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