Provider Demographics
NPI:1437696119
Name:KIRKS PHARMACY LLC
Entity Type:Organization
Organization Name:KIRKS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-724-2741
Mailing Address - Street 1:114 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-1222
Mailing Address - Country:US
Mailing Address - Phone:618-724-2741
Mailing Address - Fax:618-724-9360
Practice Address - Street 1:114 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-1222
Practice Address - Country:US
Practice Address - Phone:618-724-2741
Practice Address - Fax:618-724-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540201693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370987925001Medicaid
IL1274460001Medicare NSC