| Organization Name: | SULLIVAN DRUGS OF RAYMOND |
| NPI Number: | 1477539732 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAURICE E SULLIVAN (OWNER) |
| Mailing Address: | 801 N O Bannon Raymond |
| State: | IL US |
| Postal Code: | 62560 |
| Phone Number: | 2172293022 |
| Fax Number: | 2172293065 |
| NPI Enumeration Date: | 12/19/2005 |
| NPI Last Update Date: | 05/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 054-007502 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |