Provider Demographics
NPI:1013476662
Name:IRBY, DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:IRBY
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 1:105 APPLE RD
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-9543
Mailing Address - Country:US
Mailing Address - Phone:309-241-6119
Mailing Address - Fax:
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MACKINAW
Practice Address - State:IL
Practice Address - Zip Code:61755-7510
Practice Address - Country:US
Practice Address - Phone:309-359-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist