Active NPI
Caleb Diericx, PHARMD
- Pharmacist
- Marion, IL
National Provider Identifier
1629313630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051295840
- Practice address
- 1704 W Deyoung St
Marion, IL 62959-1054 - Phone
- (309) 993-6330
- NPI assigned
- Dec 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 019849 | KY | |
| Pharmacist | 183500000X | 051295840 | IL | Primary |
Addresses
Primary practice location
1704 W Deyoung St
Marion, IL 62959-1054
Mailing address
1704 W Deyoung St
Marion, IL 62959-1054
Phone (309) 993-6330
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051295840 | IL | MD | Pharmacist |
| 019849 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Limited Partnership I | Past | Accepting new patients | |
| Kroger Limited Partnership I | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Pekin, IL
- NPI 1457424079
-
- Community/Retail Pharmacy
- Newport, KY
- NPI 1104791078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1629313630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 W DEYOUNG ST",
"city": "MARION",
"state": "IL",
"postal_code": "629591054",
"telephone_number": "309-993-6330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 W DEYOUNG ST",
"city": "MARION",
"state": "IL",
"postal_code": "629591054",
"telephone_number": "309-993-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERICX",
"first_name": "CALEB",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-02",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "019849",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051295840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.