Provider Demographics
NPI:1043371529
Name:DISTRICT DRUGS & COMPOUNDING CENTER LTD.
Entity Type:Organization
Organization Name:DISTRICT DRUGS & COMPOUNDING CENTER LTD.
Other - Org Name:DISTRICT DRUGS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:309-786-8431
Mailing Address - Street 1:319 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8715
Mailing Address - Country:US
Mailing Address - Phone:309-786-8431
Mailing Address - Fax:309-794-6481
Practice Address - Street 1:319 18TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8715
Practice Address - Country:US
Practice Address - Phone:309-786-8431
Practice Address - Fax:309-794-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-013815333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0515577Medicaid
IL=========001Medicaid
IA0515577Medicaid