Provider Demographics
NPI:1174664395
Name:MOLINE DRUG INC.
Entity Type:Organization
Organization Name:MOLINE DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:309-762-0971
Mailing Address - Street 1:1610 15TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3959
Mailing Address - Country:US
Mailing Address - Phone:309-762-0971
Mailing Address - Fax:309-762-4722
Practice Address - Street 1:1610 15TH STREET PL
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3959
Practice Address - Country:US
Practice Address - Phone:309-762-0971
Practice Address - Fax:309-762-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0084093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1449188OtherNCPDP
ILAS2914744OtherDEA
IL1449188OtherNCPDP
ILAS2914744OtherDEA