Provider Demographics
NPI:1447362389
Name:B & D PHARMACY INC
Entity type:Organization
Organization Name:B & D PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-463-0000
Mailing Address - Street 1:1 PROFESSIONAL DR STE 170
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5069
Mailing Address - Country:US
Mailing Address - Phone:618-463-0000
Mailing Address - Fax:618-463-0008
Practice Address - Street 1:1 PROFESSIONAL DR STE 170
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5069
Practice Address - Country:US
Practice Address - Phone:618-463-0000
Practice Address - Fax:618-463-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540133433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023574OtherPK
IL=========003Medicaid
1146020001Medicare NSC