Byrd-Watson Times Square Drug Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054.009959 Issued in IL

Legal business name

BYRD-WATSON TIMES SQUARE DRUG CO

Practice address

3401 Broadway St
Mount Vernon, IL 62864-2201

Phone

(618) 244-5400

Fax

(618) 244-5988

NPI assigned

Aug 9, 2006

Organization subpart

No

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 2

Addresses

Other names 1

• Byrd-Watson Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL3 enrollments

Enrollment records 3

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.

• Byrd-Watson Times Square Drug Co

  • Long Term Care Pharmacy
  • Mount Vernon, IL
  • NPI 1043997182
  NPD tax ID

Locations

Practitioners 5

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

• Jane Iles, RPH

  • Pharmacist
  • Mount Vernon, IL
  • NPI 1316538135
  NPD
• Christopher Michael Herman, RPH

  • Pharmacotherapy Pharmacist
  • Mount Vernon, IL
  • NPI 1346674322
  NPD (past)
• Donald D May, RPH

  • Pharmacist
  • Nashville, IL
  • NPI 1902129299
  NPD (past)
• Laura Olsen, PHARMD

  • Pharmacist
  • Mount Vernon, IL
  • NPI 1104372911
  NPD (past)
• Kimberly Wieter, RPH

  • Pharmacist
  • Centralia, IL
  • NPI 1821690728
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1598775413",
    "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",
            "fax_number": "618-244-5988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYRD-WATSON TIMES SQUARE DRUG CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "054009959",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.009959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Byrd-Watson Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derek Burns, PHARMD
• Michelle Burwell, PA-C
• Patricia Claire Butler
• Byrd-Watson South 9TH Drug Co
• Byrd-Watson Times Square Drug Co
• Thomas J. Cain, CRNA
• Patricia Isabel Calcetto, CRNA
• Hannah Capps, MHP
• Tiffany Capps, BSN, RN
• Caravilla Residential Centers, Inc

• Community/Retail Pharmacy in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Community/Retail Pharmacy in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.