Healthcare Provider Details

I. General information

NPI: 1417874736
Provider Name (Legal Business Name): ERIC M SPIRES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 N GRANDVIEW DRIVE
PEORIA IL
61614
US

IV. Provider business mailing address

4017 N GRANDVIEW DRIVE
PEORIA IL
61614
US

V. Phone/Fax

Practice location:
  • Phone: 309-635-9639
  • Fax:
Mailing address:
  • Phone: 309-635-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043938
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.040196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: