Provider Demographics
NPI:1730246158
Name:FELKER PHARMACY INC
Entity type:Organization
Organization Name:FELKER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-765-1300
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-0427
Mailing Address - Country:US
Mailing Address - Phone:815-335-3535
Mailing Address - Fax:815-335-1186
Practice Address - Street 1:101 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-7702
Practice Address - Country:US
Practice Address - Phone:815-335-3535
Practice Address - Fax:815-335-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL540144213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020779OtherPK
2020779OtherPK
0849300005Medicare NSC