Provider Demographics
NPI:1518247147
Name:HARCAR, CAROL LYNN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:HARCAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2901
Mailing Address - Country:US
Mailing Address - Phone:815-673-2439
Mailing Address - Fax:
Practice Address - Street 1:7 CLOVER CT
Practice Address - Street 2:
Practice Address - City:GRAND RIDGE
Practice Address - State:IL
Practice Address - Zip Code:61325-9795
Practice Address - Country:US
Practice Address - Phone:815-579-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362127039438Medicaid