Fagen Pharmacy 15

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

FAGEN PHARMACY 15

Doing business as

Demotte Drugs Inc

Practice address

11112 Front St
Mokena, IL 60448-1562

Phone

(708) 479-9333

Fax

(708) 479-5633

NPI assigned

Jul 21, 2006

Last updated

Sep 11, 2025By 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

Larry Wojcik

Title

3Rd Party Coord

Phone

(219) 987-6468

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• DEMOTTE DRUGS INC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marjorie Laciak, PHARMD

  • Pharmacist
  • Valparaiso, IN
  • NPI 1699060988
  NPD

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1861413189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAGEN PHARMACY",
            "address_2": "PO BOX 9830",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841099913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11112 FRONT ST",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481562",
            "telephone_number": "708-479-9333",
            "fax_number": "708-479-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAGEN PHARMACY 15",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WOJCIK",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "3RD PARTY COORD",
        "authorized_official_telephone_number": "219-987-6468"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54014975",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1475880",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEMOTTE DRUGS INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Basant Elsharkawy, PHARMD
• Erickson Ambulance LLC
• Kelli Evans, FNP-BC
• Zola Evans, L.AC., DIPL. O.M.
• Victoria O. Fadiya, DNP
• Family Medicine Physicians Organization
• Anita Lyn Farley, FNP
• Shonda Lynn Farris, RN, MSN, FNP-BC
• Sophia Feliciano
• Alexander Ethan Feller, M.D.

• Long Term Care Pharmacy in Mokena, IL
• Providers in Mokena, IL by specialty
• Long Term Care Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.