MEDICARE: EXTENDED PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	64002202A	IN
2	3336L0003X	Long Term Care Pharmacy	2015044792	MO
3	3336L0003X	Long Term Care Pharmacy	054016704	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2120962	OTHER		PK

General Provider Information

NPI Number	:	1700014446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED PHARMACY LLC

Provider Business Mailing Address
First Line	:	121 STATE ST STE 1A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61602-1547
Country	:	US
Telephone Number	:	309-676-4831
Fax Number	:	309-676-7014

Provider Business Practice Location Address
First Line	:	121 STATE ST STE 1A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61602-1547
Country	:	US
Telephone Number	:	309-676-4831
Fax Number	:	309-676-7014

Authorized Official
Title or Position	:	MANAGER
Name	:	ERIC SPIRES
Credential	:
Telephone Number	:	309-676-4831

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	03/14/2023

Similar Medicare Providers

1922097096 — ACTION MOBILITY INC
Practice Location Address:

2104 W TOWNLINE RD
PEORIA, IL
61615-1547

Practice Phone: 309-674-8550
Practice Fax: 309-674-8505

1518284587 — COMPLETE HOME RESPIRATORY CARE LLC
Practice Location Address:

2108 W TOWNLINE RD
PEORIA, IL
61615-1547

Practice Phone: 309-689-5038
Practice Fax: 309-689-5074

1023392628 — MRS. KELLEY MARIE MESSMER RPH
Practice Location Address:

2106 W TOWNLINE RD
PEORIA, IL
61615-1547

Practice Phone: 309-692-2826
Practice Fax:

1811733801 — EVELYN CROWLEY
Practice Location Address:

815 MAIN ST STE C
PEORIA, IL
61602-1080

Practice Phone: 309-672-4977
Practice Fax:

1598609372 — MATTHEW KYLE HOELSCHER
Practice Location Address:

815 MAIN ST STE C
PEORIA, IL
61602-1080

Practice Phone: 309-672-4986
Practice Fax:

1700573151 — DR. RONALD LEE LOMBARD AGPCNP-BC, DNP
Practice Location Address:

222 NE MONROE ST STE 904
PEORIA, IL
61602-1066

Practice Phone: 309-224-5621
Practice Fax:

Directions to “EXTENDED PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.