Lincolnshire Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054008911 Issued in IL

Legal business name

LINCOLNSHIRE PHARMACY

Practice address

4230 Lincolnshire Dr
Suite F
Mount Vernon, IL 62864-2189

Phone

(618) 244-3044

Fax

(618) 244-3067

NPI assigned

Feb 14, 2007

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joe Gene Wilks, R.PH.

Title

Owner

Phone

(618) 244-3044

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1336282276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 LINCOLNSHIRE DR",
            "address_2": "SUITE F",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642189",
            "telephone_number": "618-244-3044",
            "fax_number": "618-244-3067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 LINCOLNSHIRE DR",
            "address_2": "SUITE F",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642189",
            "telephone_number": "618-244-3044",
            "fax_number": "618-244-3067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLNSHIRE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-244-3044",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054008911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1452729",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.