Provider Demographics
NPI:1346382504
Name:PHIL'S PRESCRIPTION DRUGS, INC.
Entity Type:Organization
Organization Name:PHIL'S PRESCRIPTION DRUGS, INC.
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILLER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-684-2341
Mailing Address - Street 1:1340 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2025
Mailing Address - Country:US
Mailing Address - Phone:618-684-2341
Mailing Address - Fax:618-687-2363
Practice Address - Street 1:1340 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2025
Practice Address - Country:US
Practice Address - Phone:618-684-2341
Practice Address - Fax:618-687-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid