Provider Demographics
NPI:1831364280
Name:FELKERS SNYDER PHARMACY
Entity type:Organization
Organization Name:FELKERS SNYDER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-284-8000
Mailing Address - Street 1:301 N GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2113
Mailing Address - Country:US
Mailing Address - Phone:815-284-8000
Mailing Address - Fax:815-284-8005
Practice Address - Street 1:301 N GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2113
Practice Address - Country:US
Practice Address - Phone:815-284-8000
Practice Address - Fax:815-284-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
IL0849300006Medicare PIN