Provider Demographics
NPI:1225032071
Name:R & Q CORPORATION
Entity Type:Organization
Organization Name:R & Q CORPORATION
Other - Org Name:WOLTERS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:309-543-2253
Mailing Address - Street 1:201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1137
Mailing Address - Country:US
Mailing Address - Phone:309-543-2253
Mailing Address - Fax:309-543-3471
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1137
Practice Address - Country:US
Practice Address - Phone:309-543-2253
Practice Address - Fax:309-543-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1463316OtherNAPB
IL=========001Medicaid
IL1463316OtherNAPB
IL=========001MedicaidMEDICAID