Provider Demographics
NPI:1043393598
Name:MASON COUNTY DRUGS, INC
Entity Type:Organization
Organization Name:MASON COUNTY DRUGS, INC
Other - Org Name:BEEKMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEEKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-496-6063
Mailing Address - Street 1:420 CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-9640
Mailing Address - Country:US
Mailing Address - Phone:217-496-2600
Mailing Address - Fax:217-496-3900
Practice Address - Street 1:420 CROSSING DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9640
Practice Address - Country:US
Practice Address - Phone:217-496-2600
Practice Address - Fax:217-496-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054017499333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054.017499OtherSTATE LICENSE
IL1460411OtherNCPDP #
ILFM2194897OtherDEA LICENSE
IL=========003Medicaid