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General NPI Number Information
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NPI Number | 1083701270
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Entity Type | Organization
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Legal Business Name | FAMILY CARE PHARMACY, INC
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1108 BROADWAY
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City | HIGHLAND
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State | IL
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Zip | 62249
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Country | US
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Telephone | 618-882-5028
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Fax | 618-882-5049
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Provider Business Mailing Address
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Address Line | 1108 BROADWAY
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City | HIGHLAND
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State | IL
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Zip | 62249-1917
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Country | US
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Telephone | 618-654-2323
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Fax | 618-654-5454
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL FIEKER
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Credential | RPH
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Telephone | 618-654-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054002142
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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