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General NPI Number Information
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NPI Number | 1437696119
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Entity Type | Organization
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Legal Business Name | KIRKS PHARMACY LLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 114 W MARKET ST
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City | CHRISTOPHER
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State | IL
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Zip | 62822-1222
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Country | US
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Telephone | 618-724-2741
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Fax | 618-724-9360
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Provider Business Mailing Address
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Address Line | 114 W MARKET ST
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City | CHRISTOPHER
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State | IL
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Zip | 62822-1222
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Country | US
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Telephone | 618-724-2741
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Fax | 618-724-9360
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Authorized Official
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Title or Position | OWNER/RPH
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Name | MR. JAMES W KIRKPATRICK
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Credential | RPH
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Telephone | 618-724-2741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054020169
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License Number State | IL
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