Provider Demographics
NPI:1619398641
Name:KIRKLYS, JOHN A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:KIRKLYS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DARROW AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3247
Mailing Address - Country:US
Mailing Address - Phone:773-774-7374
Mailing Address - Fax:
Practice Address - Street 1:2209 HOWARD ST
Practice Address - Street 2:C/O TARGET PHARMACY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3636
Practice Address - Country:US
Practice Address - Phone:847-733-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-037937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist