Provider Demographics
NPI:1477664472
Name:C V KASIAR LTD
Entity Type:Organization
Organization Name:C V KASIAR LTD
Other - Org Name:BECKS DRUGS A DIV OF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:KASIAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-273-8111
Mailing Address - Street 1:1409 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1629
Mailing Address - Country:US
Mailing Address - Phone:618-273-8111
Mailing Address - Fax:618-273-8165
Practice Address - Street 1:1409 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1629
Practice Address - Country:US
Practice Address - Phone:618-273-8111
Practice Address - Fax:618-273-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054008355333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid