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BYRD-WATSON TIMES SQUARE DRUG CO NPI 1598775413


NPI Information

NPI: 1598775413
Provider Name: BYRD-WATSON TIMES SQUARE DRUG CO
Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 14D2187376

Address:
3401 BROADWAY ST
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 244-5400
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BYRD-WATSON TIMES SQUARE DRUG CO is a community/retail pharmacy pharmacy in Mount Vernon, IL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. BYRD-WATSON TIMES SQUARE DRUG CO NPI is 1598775413. The provider is registered as an organization entity type.

The provider's business location address is:

3401 BROADWAY ST
MOUNT VERNON, IL
ZIP 62864-201
Phone: (618) 244-5400

The provider's authorized official is Adam Breeze .
The authorized official title is Owner and has the following contact phone number (618) 242-2800.

The CLIA number assigned to this NPI record is 14D2187376 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2006 and was last updated on 8/8/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical Supplies054009959ILLINOISNo
23336C0003XPharmacyCommunity/Retail Pharmacy054.009959ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10214900001MEDICARE NSCILLINOIS
2=========TOTHERILLINOISBLUECROSS BLUE SHIELD
3=========001MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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