NPIMap

Organization Active NPI

Byrd-Watson Times Square Drug Co

  • Long Term Care Pharmacy
  • Mount Vernon, IL
National Provider Identifier
1043997182
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
BYRD-WATSON TIMES SQUARE DRUG CO
Practice address
3401 Broadway St
Mount Vernon, IL 62864-2201
Phone
(618) 244-5400
NPI assigned
Jun 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Adam Breeze
Title
Officer of the Corporation
Phone
(618) 244-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

3401 Broadway St
Mount Vernon, IL 62864-2201

Mailing address

PO Box 1179
Mount Vernon, IL 62864-0024
Phone (618) 244-5400

Other names 1

  • Byrd-Watson Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Byrd-Watson Times SQ Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1043997182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1179",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628640024",
            "telephone_number": "618-244-5400",
            "fax_number": "618-244-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 BROADWAY ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642201",
            "telephone_number": "618-244-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYRD-WATSON TIMES SQUARE DRUG CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "BREEZE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OFFICER OF THE CORPORATION",
        "authorized_official_telephone_number": "618-244-5400"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Byrd-Watson Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.