Provider Demographics
NPI:1376547133
Name:R & Q CORPORATION
Entity Type:Organization
Organization Name:R & Q CORPORATION
Other - Org Name:MANITO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:309-543-2253
Mailing Address - Street 1:406 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANITO
Mailing Address - State:IL
Mailing Address - Zip Code:61546-9315
Mailing Address - Country:US
Mailing Address - Phone:309-968-2800
Mailing Address - Fax:309-968-2807
Practice Address - Street 1:406 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANITO
Practice Address - State:IL
Practice Address - Zip Code:61546-9315
Practice Address - Country:US
Practice Address - Phone:309-968-2800
Practice Address - Fax:309-968-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054013848333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1468479OtherNABP
IL=========002Medicaid
IL1468479OtherNABP