NPIMap

Organization Active NPI

K&S Pharmacies of Southern Illinois LTD

Doing business as Moody Pharmacy

  • Pharmacy
  • Sparta, IL
National Provider Identifier
1649264722
Registry record updated Oct 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
054015396 Issued in IL
Legal business name
K&S PHARMACIES OF SOUTHERN ILLINOIS LTD
Doing business as
Moody Pharmacy
Practice address
157 W Broadway St
Sparta, IL 62286-1619
Phone
(618) 443-2715
Fax
(618) 443-6218
NPI assigned
Sep 6, 2005
Last updated
Oct 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2018

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

Authorized official

Name
Dr. Seamus N Kloos, PHARM.D.NPI 1174647887
Title
Corp Treasurer/Pharmacist in Charge
Phone
(618) 443-2715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 054015396 IL Primary

Addresses

Primary practice location

157 W Broadway St
Sparta, IL 62286-1619

Mailing address

157 W Broadway St
Sparta, IL 62286-1619
Phone (618) 443-2715

Other identifiers 3

IdentifierTypeStateIssuer
032008353OtherILSTATE CONTROLLED SUBSTANE
054015396OtherILSTATE LICENSE NUMBER
1427310OtherNCPDP NUMBER

Other names 1

  • Moody Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

157 W Broadway St
Sparta, IL 62286
Phone (618) 443-2715

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1649264722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 W BROADWAY ST",
            "city": "SPARTA",
            "state": "IL",
            "postal_code": "622861619",
            "telephone_number": "618-443-2715",
            "fax_number": "618-443-6218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 W BROADWAY ST",
            "city": "SPARTA",
            "state": "IL",
            "postal_code": "622861619",
            "telephone_number": "618-443-2715",
            "fax_number": "618-443-6218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K&S PHARMACIES OF SOUTHERN ILLINOIS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2018-10-03",
        "status": "A",
        "authorized_official_last_name": "KLOOS",
        "authorized_official_first_name": "SEAMUS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CORP TREASURER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "618-443-2715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054015396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CONTROLLED SUBSTANE",
            "identifier": "032008353",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "054015396",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "1427310",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moody Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moody Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparta, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.