MEDICARE: BULLDOG ALLIANCE 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	:	1124018957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULLDOG ALLIANCE INC.

Provider Business Mailing Address
First Line	:	318 S PLAZA PARK
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-2214
Country	:	US
Telephone Number	:	309-274-9571
Fax Number	:	309-274-8630

Provider Business Practice Location Address
First Line	:	318 S PLAZA PARK
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-2214
Country	:	US
Telephone Number	:	309-274-9571
Fax Number	:	309-274-8630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID L NEWELL
Credential	:	R.PH.
Telephone Number	:	309-274-9571

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/22/2020

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Directions to “BULLDOG ALLIANCE INC. ” Practice Location

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