Active NPI
Larry E Korelc, RPH.
- Pharmacist
- Minooka, IL
National Provider Identifier
1093835969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 51028347
- Practice address
- 508 W Mondamin St
Minooka, IL 60447-9460 - Phone
- (815) 467-2288
- Fax
- (815) 467-7720
- NPI assigned
- Apr 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 51028347 | IL | Primary |
Addresses
Primary practice location
508 W Mondamin St
Minooka, IL 60447-9460
Mailing address
508 W Mondamin St
P.O. Box 190
Minooka, IL 60447-9460
Phone (815) 467-2288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51028347 | Other | IL | STATE PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51028347 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093835969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 W MONDAMIN ST",
"address_2": "P.O. BOX 190",
"city": "MINOOKA",
"state": "IL",
"postal_code": "604479460",
"telephone_number": "815-467-2288",
"fax_number": "815-467-7720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 W MONDAMIN ST",
"city": "MINOOKA",
"state": "IL",
"postal_code": "604479460",
"telephone_number": "815-467-2288",
"fax_number": "815-467-7720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORELC",
"first_name": "LARRY",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "51028347",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PHARMACIST LICENSE",
"identifier": "51028347",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minooka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.