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General NPI Number Information
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NPI Number | 1649264722
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Entity Type | Organization
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Legal Business Name | K&S PHARMACIES OF SOUTHERN ILLINOIS LTD
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 157 W BROADWAY ST
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City | SPARTA
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State | IL
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Zip | 62286-1619
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Country | US
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Telephone | 618-443-2715
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Fax | 618-443-6218
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Provider Business Mailing Address
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Address Line | 157 W BROADWAY ST
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City | SPARTA
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State | IL
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Zip | 62286-1619
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Country | US
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Telephone | 618-443-2715
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Fax | 618-443-6218
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Authorized Official
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Title or Position | CORP TREASURER/PHARMACIST IN CHARGE
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Name | DR. SEAMUS N KLOOS
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Credential | PHARM.D.
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Telephone | 618-443-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054015396
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License Number State | IL
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