Provider Demographics
NPI:1740264340
Name:DOT DRUG INC.
Entity type:Organization
Organization Name:DOT DRUG INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-383-3000
Mailing Address - Street 1:505 JUBILEE LN
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-8472
Mailing Address - Country:US
Mailing Address - Phone:309-383-3000
Mailing Address - Fax:309-383-3048
Practice Address - Street 1:505 JUBILEE LN
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-8472
Practice Address - Country:US
Practice Address - Phone:309-383-3000
Practice Address - Fax:309-383-3048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOT DRUG INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054014334333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1472947OtherNABP
IL1472947OtherNABP
IL=========004Medicaid
IL0269760005Medicare NSC