Sullivan Drugs of Staunton

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054004541 Issued in IL

Legal business name

SULLIVAN DRUGS OF STAUNTON

Doing business as

Sullivan Drugs

Practice address

101 E Main St
Staunton, IL 62088-1446

Phone

(618) 635-2595

Fax

(618) 635-5590

NPI assigned

Dec 12, 2005

Last updated

Jun 9, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maurice Sullivan, R.PH.NPI 1770508749

Title

President

Phone

(217) 839-2909

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• SULLIVAN DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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.

• Maurice E Sullivan, R. PH.

  • Pharmacist
  • Raymond, IL
  • NPI 1770508749
  Authorized official Same address or phone
• John B Caldieraro Jr., RPH

  • Pharmacist
  • Staunton, IL
  • NPI 1447373311
  NPD (past)
• Richard Charles Heller, R.PH.

  • Pharmacist
  • Litchfield, IL
  • NPI 1568712339
  NPD (past)
• Harry Michael Zollars, PHARMD

  • Pharmacist
  • Maryville, IL
  • NPI 1679989503
  NPD (past)

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

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1902881097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E MAIN ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881446",
            "telephone_number": "618-635-2595",
            "fax_number": "618-635-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E MAIN ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881446",
            "telephone_number": "618-635-2595",
            "fax_number": "618-635-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN DRUGS OF STAUNTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-12",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-839-2909",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054004541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2016642",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SULLIVAN DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ted Samuel Thalmann, RPH
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• Ajin Varghese, FNP-C

• Community/Retail Pharmacy in Staunton, IL
• Providers in Staunton, 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 Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.