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ERNEST & SUSAN L ROALES NPI 1346243672


NPI Information

NPI: 1346243672
Provider Name: ERNEST & SUSAN L ROALES

Doing Business As: SCOTTS DRUGS

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
208 N MAIN ST
BRIDGEPORT, IL
ZIP 62417
Phone: (618) 945-3701
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ERNEST & SUSAN L ROALES is a community/retail pharmacy pharmacy in Bridgeport, 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. ERNEST & SUSAN L ROALES NPI is 1346243672. The provider is registered as an organization entity type.
The provider Is Doing Business As Scotts Drugs.

The provider's business location address is:

208 N MAIN ST
BRIDGEPORT, IL
ZIP 62417-522
Phone: (618) 945-3701
Fax: (618) 945-3701

The provider's authorized official is Ernest Roales .
The authorized official title is Owner and has the following contact phone number (618) 945-3701.

The enumeration date for this NPI number is 5/31/2005 and was last updated on 2/21/2017.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail Pharmacy054008755ILLINOISYes
33336C0004XPharmacyCompounding PharmacyNo

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12018808OTHERPK
20455460001MEDICARE NSC
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: 5/5/2024

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