Provider Demographics
NPI:1164719019
Name:COCKERILL, KRISTINE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:COCKERILL
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 1:906 SUMMERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-3631
Mailing Address - Country:US
Mailing Address - Phone:217-243-7818
Mailing Address - Fax:217-243-1915
Practice Address - Street 1:134 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2811
Practice Address - Country:US
Practice Address - Phone:217-243-7818
Practice Address - Fax:217-243-1915
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist