Healthcare Provider Details

I. General information

NPI: 1437696119
Provider Name (Legal Business Name): KIRKS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W MARKET ST
CHRISTOPHER IL
62822-1222
US

IV. Provider business mailing address

114 W MARKET ST
CHRISTOPHER IL
62822-1222
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-2741
  • Fax: 618-724-9360
Mailing address:
  • Phone: 618-724-2741
  • Fax: 618-724-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054020169
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES W KIRKPATRICK
Title or Position: OWNER/RPH
Credential: RPH
Phone: 618-724-2741