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General NPI Number Information
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NPI Number | 1568733673
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Entity Type | Organization
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Legal Business Name | SULLIVAN DRUGS OF LITCHFIELD INC
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 320 E UNION AVE
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City | LITCHFIELD
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State | IL
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Zip | 62056-1575
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Country | US
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Telephone | 217-324-2001
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Fax | 217-324-6001
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Provider Business Mailing Address
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Address Line | 320 E UNION AVE
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City | LITCHFIELD
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State | IL
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Zip | 62056-1575
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Country | US
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Telephone | 217-324-2001
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Fax | 217-324-6001
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Authorized Official
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Title or Position | V.P./TRES
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Name | MAURICE SULLIVAN
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Credential |
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Telephone | 217-839-2909
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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 | 054.017871
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License Number State | IL
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