Maurice E Sullivan
Organization Active NPI Community/Retail Pharmacy · Raymond, IL
NPI 1477539732 · NPPES record last updated Feb 16, 2017
Key facts
- NPI
- 1477539732
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054007502 (IL)
- Legal business name
- MAURICE E SULLIVAN
- Practice address
- 801 N Obannon St
Raymond, IL 62560-5283 - Phone
- (217) 229-3022
- Fax
- (217) 229-3065
- NPI assigned
- Dec 19, 2005
- Organization subpart
- No
Authorized official
- Name
- Maurice Sullivan, R.PH.
- Title
- Owner
- Phone
- (217) 839-2909
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054007502 | IL | Yes |
Addresses
Primary practice location
801 N Obannon St
Raymond, IL 62560-5283
Mailing address
PO Box 588
Raymond, IL 62560-0588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2018616 | Other | PK | |
| 323389477001 | Medicaid | IL |
Other names
- SULLIVAN DRUG OF RAYMOND
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- Ellen Edith Mouser
- Panhandle Cusd 2
- Raymond Harvel Area Ambulance Service
- Springfield Clinic LLP
- Maurice E Sullivan
All providers in Raymond, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.