Provider Demographics
NPI:1093835969
Name:KORELC, LARRY E (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:E
Last Name:KORELC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W MONDAMIN ST
Mailing Address - Street 2:P.O. BOX 190
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9460
Mailing Address - Country:US
Mailing Address - Phone:815-467-2288
Mailing Address - Fax:815-467-7720
Practice Address - Street 1:508 W MONDAMIN ST
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9460
Practice Address - Country:US
Practice Address - Phone:815-467-2288
Practice Address - Fax:815-467-7720
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51028347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL51028347OtherSTATE PHARMACIST LICENSE