Provider Demographics
NPI:1417950387
Name:ST. JOSEPH DRUGS, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH DRUGS, INC.
Other - Org Name:ST. JOSEPH APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNDAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-469-2232
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873-0500
Mailing Address - Country:US
Mailing Address - Phone:217-469-2232
Mailing Address - Fax:217-469-2381
Practice Address - Street 1:204 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873-0500
Practice Address - Country:US
Practice Address - Phone:217-469-2232
Practice Address - Fax:217-469-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054011849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL032004839OtherCONTROLLED SUBSTANCE LIC
IL054011849OtherPHARMACY LICENSE
IL1427726OtherNABP #
IL1097140001Medicare NSC