Renes Drug Store Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

054005099 Issued in IL

Legal business name

RENES DRUG STORE INC

Practice address

201 West Main Cross
Taylorville, IL 62568-2247

Phone

(217) 824-3533

Fax

(217) 824-3492

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Gordon John Mazzotti, LICENSED REGISTEREDNPI 1689235749

Title

President Chief Executive Officer

Phone

(217) 824-3533

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Gordon John Mazzotti, R PH

  • Pharmacist
  • Taylorville, IL
  • NPI 1689235749
  NPD (past) Authorized official

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1114095320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 WEST MAIN CROSS",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682247",
            "telephone_number": "217-824-3533",
            "fax_number": "217-824-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 WEST MAIN CROSS",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682247",
            "telephone_number": "217-824-3533",
            "fax_number": "217-824-3492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENES DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "MAZZOTTI",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "217-824-3533",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICENSED REGISTERED"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054005099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory R Polovich
• Amanda Dawn Prather
• Progressive Housing, Inc
• Dennis W Rabe, OD
• Rene'S Drug Store, Inc
• Emily Repscher
• Residential Horizons Inc.
• Kristina M. Rexroad, NP
• Bryan D Rice, CRNA
• Tiffany Rickman, MPH, RDN, LDN

• Pharmacy in Taylorville, IL
• Providers in Taylorville, IL by specialty
• Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.