Provider Demographics
NPI:1942388038
Name:WARREN DRUG STORE, INC.
Entity Type:Organization
Organization Name:WARREN DRUG STORE, INC.
Other - Org Name:WARREN DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-745-3700
Mailing Address - Street 1:137 EAST MAIN STREET
Mailing Address - Street 2:PO BOX 626
Mailing Address - City:WARREN
Mailing Address - State:IL
Mailing Address - Zip Code:61087
Mailing Address - Country:US
Mailing Address - Phone:815-745-3700
Mailing Address - Fax:815-745-3663
Practice Address - Street 1:137 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IL
Practice Address - Zip Code:61087
Practice Address - Country:US
Practice Address - Phone:815-745-3700
Practice Address - Fax:815-745-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33271100Medicaid
IL=========001Medicaid
WI33271100Medicaid