Active NPI
Elaine Mary Grimes
- Pharmacist
- Flora, IL
National Provider Identifier
1336743293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051034921
- Practice address
- 1301 N State Rd
Flora, IL 62839-1093 - Phone
- (618) 662-4767
- Fax
- (618) 662-2657
- NPI assigned
- Nov 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 051034921 | IL | Primary |
Addresses
Primary practice location
1301 N State Rd
Flora, IL 62839-1093
Mailing address
PO Box 714
Olney, IL 62450-0714
Phone (618) 838-7835
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051034921 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606003200000",
"number": "1336743293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 714",
"city": "OLNEY",
"state": "IL",
"postal_code": "624500714",
"telephone_number": "618-838-7835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 N STATE RD",
"city": "FLORA",
"state": "IL",
"postal_code": "628391093",
"telephone_number": "618-662-4767",
"fax_number": "618-662-2657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "ELAINE",
"middle_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-22",
"last_updated": "2020-11-22",
"certification_date": "2020-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051034921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.