NPIMap

Organization Active NPI

Pekin Prescription Laboratory, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Pekin, IL
National Provider Identifier
1487603296
Registry record updated Mar 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
203-0007711 Issued in IL
Legal business name
PEKIN PRESCRIPTION LABORATORY, INC.
Practice address
1016 Court St
Pekin, IL 61554-4818
Phone
(309) 346-2141
Fax
(309) 346-7903
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2015

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

Authorized official

Name
Mr. Mark L. Probasco, R.PH.
Title
President
Phone
(309) 346-2141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 203-0007711 IL Primary
Community/Retail Pharmacy 3336C0003X 054.017927 IL

Addresses

Primary practice location

1016 Court St
Pekin, IL 61554-4818

Mailing address

1016 Court St
Pekin, IL 61554-4818
Phone (309) 346-2141

National Provider Directory

National Provider Directory

Locations

1016 Court St
Pekin, IL 61554
Phone (309) 346-2141

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1487603296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 COURT ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544818",
            "telephone_number": "309-346-2141",
            "fax_number": "309-346-7903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 COURT ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615544818",
            "telephone_number": "309-346-2141",
            "fax_number": "309-346-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEKIN PRESCRIPTION LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "PROBASCO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-346-2141",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203-0007711",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.017927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pekin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; 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.