Provider Demographics
NPI:1740346014
Name:FELKER PHARMACY INC
Entity type:Organization
Organization Name:FELKER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-765-1300
Mailing Address - Street 1:201 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1418
Mailing Address - Country:US
Mailing Address - Phone:815-732-7340
Mailing Address - Fax:815-732-7228
Practice Address - Street 1:201 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1418
Practice Address - Country:US
Practice Address - Phone:815-732-7340
Practice Address - Fax:815-732-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0119153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2022419OtherPK
IL=========002Medicaid
0849300002Medicare NSC