Provider Demographics
NPI:1164623161
Name:KIRKUS, MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KIRKUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1983
Mailing Address - Country:US
Mailing Address - Phone:708-352-5747
Mailing Address - Fax:708-352-9937
Practice Address - Street 1:507 E WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1983
Practice Address - Country:US
Practice Address - Phone:708-352-5747
Practice Address - Fax:708-352-9937
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist