MEDICARE: W R SMITH DRUG STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy		IL

General Provider Information

NPI Number	:	1073501318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W R SMITH DRUG STORES INC

Provider Business Mailing Address
First Line	:	2502 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3622
Country	:	US
Telephone Number	:	309-685-5221
Fax Number	:	309-685-1994

Provider Business Practice Location Address
First Line	:	2502 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3622
Country	:	US
Telephone Number	:	309-685-5221
Fax Number	:	309-685-1994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CYNTHIA L WEBB
Credential	:
Telephone Number	:	309-685-5221

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2020

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Directions to “W R SMITH DRUG STORES INC ” Practice Location

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