Provider Demographics
NPI:1568486165
Name:CAINS DRUG STORE INC
Entity Type:Organization
Organization Name:CAINS DRUG STORE INC
Other - Org Name:CAINS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TJADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-0196
Mailing Address - Street 1:1401 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1028
Mailing Address - Country:US
Mailing Address - Phone:618-283-0196
Mailing Address - Fax:618-283-9150
Practice Address - Street 1:1401 N 8TH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1028
Practice Address - Country:US
Practice Address - Phone:618-283-0196
Practice Address - Fax:618-283-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IL054.0086833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016689OtherPK
IL=========0001Medicaid
IL=========0001Medicaid