Instarx Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054.020874 Issued in IL

Legal business name

INSTARX PHARMACY LLC

Practice address

18927 Hickory Creek Dr Ste 135
Mokena, IL 60448

Phone

(708) 478-0119

Fax

(708) 478-0147

NPI assigned

Aug 12, 2018

Organization subpart

No

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

Authorized official

Name

Brian Fitzsimmons

Title

Ceo

Phone

(708) 478-0119

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1534032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1881173656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18927 HICKORY CREEK DR STE 135",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488649",
            "telephone_number": "708-478-0119",
            "fax_number": "708-478-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18927 HICKORY CREEK DR STE 135",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "60448",
            "telephone_number": "708-478-0119",
            "fax_number": "708-478-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTARX PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-12",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "FITZSIMMONS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-478-0119"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.020874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS BOARD OF PHARMACY LICENSED PHARMACY",
            "identifier": "054.020874",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS BOARD OF PHARMACY  LICENSED CONTROLLED SUBSTANCE LICENSE",
            "identifier": "320.012772",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Mokena, IL
• Providers in Mokena, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.