Active NPI
Kelly Quon, PHARMD
- Pharmacist
- Ottawa, IL
National Provider Identifier
1821699174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.299048
- Practice address
- 4041 Veterans Dr
Ottawa, IL 61350-9602 - Phone
- (815) 434-0176
- Fax
- (815) 434-1591
- NPI assigned
- Nov 3, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 76643 | CA | |
| Pharmacist | 183500000X | 051.299048 | IL | Primary |
Addresses
Primary practice location
4041 Veterans Dr
Ottawa, IL 61350-9602
Mailing address
1804 Moran Dr
Shorewood, IL 60404-1254
Phone (309) 363-5429
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 |
|---|---|---|---|
| 76643 | CA | MD | Pharmacist |
| 051.299048 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1821699174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 MORAN DR",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604041254",
"telephone_number": "309-363-5429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4041 VETERANS DR",
"city": "OTTAWA",
"state": "IL",
"postal_code": "613509602",
"telephone_number": "815-434-0176",
"fax_number": "815-434-1591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUON",
"first_name": "KELLY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "76643",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.299048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottawa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.