Provider Demographics
NPI:1073095592
Name:BODE DRUG INC
Entity Type:Organization
Organization Name:BODE DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-748-9253
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62963-0110
Mailing Address - Country:US
Mailing Address - Phone:573-270-5013
Mailing Address - Fax:618-748-9850
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:IL
Practice Address - Zip Code:62963-1163
Practice Address - Country:US
Practice Address - Phone:618-748-9253
Practice Address - Fax:618-748-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540132313336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid