EXTENDED PHARMACY LLC (NPI# 1700014446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700014446 |
| Entity Type | Organization |
| Organization Name | EXTENDED PHARMACY LLC |
| Other Organization Name | EXTENDED PHARMACY LLC |
| Practice Address |
121 State St Ste 1a Peoria IL 61602-1547 |
| Practice Telephone | 3096764831 |
| Practice Fax Number | 3096767014 |
| Mailing Telephone | 3096764831 |
| Mailing Fax Number | 3096767014 |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2017-02-27 |
| Authorized Official Name | ERIC SPIRES (MANAGER) |
| Authorized Official Telephone | 3096764831 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | 64002202A | IN | Suppliers |
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
2015044792 | MO | Suppliers |
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
054016704 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2120962 | 01 |
| Other Name | Type Code |
|---|---|
| Extended Pharmacy LLC | Doing Business As Name - Organization |
| Street Address |
121 STATE ST STE 1A |
| City | PEORIA |
| State | IL |
| Zip Code | 61602-1547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1235675836 | Cheryl Beckman | Registered Nurse | 211 Fulton Street, Suite 207, One Technology Plaza, Peoria, IL 61602 | 2017-01-06 |
| 1063957942 | Rosemary Ince | Registered Nurse | 211 Fulton St. Suite 207, One Technology Plaza, Peoria, IL 61602 | 2016-12-30 |
| 1962674820 | Lisa Jean Burckhartzmeyer | Psychiatry & Neurology | 228 Ne Jefferson St, Peoria, IL 61602 | 2008-03-31 |
| 1669503587 | Jill Larson | Counselor | 330 Sw Washington Street, Peoria, IL 61602 | 2007-03-09 |
| 1265407399 | Cardiac Consultants Sc | Internal Medicine | 900 Main Street, Suite 320, Peoria, IL 61602 | 2006-02-22 |
| 1013364470 | Rafal Szymczuk | Student in an Organized Health Care Education/Training Program | 900 Main Street, Suite 720, Peoria, IL 61602 | 2016-05-16 |
| 1043693831 | Kari Beth Watts | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-06-30 |
| 1881072791 | Kristen Dent | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-05-12 |
| 1023422797 | Andrew Wang | Psychiatry & Neurology | 900 Main St Ste 580, Peoria, IL 61602 | 2014-06-20 |
| Find all providers in zip 61602 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1033149158 | Enloe Drugs, LLC | Pharmacy | 2305 W Altorfer Dr, Peoria, IL 61615-1809 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912512989 | Millenium Pharmacy Ltd | Pharmacy | 10604 Southwest Hwy Ste 102, Chicago Ridge, IL 60415-2704 | 2020-09-15 |
| 1992265235 | Illini Clinic Pharmacy Inc | Pharmacy | 211 S 1st Street, Alpha, IL 61413 | 2019-03-22 |
| 1750841342 | Illini Clinic Pharmacy Inc | Pharmacy | 855 Illini Dr Ste 200, Silvis, IL 61282-2904 | 2019-03-21 |
| 1679039358 | Remedi Seniorcare of Chicago, LLC | Pharmacy | 3600 Lacey Road, Suite 500, Downers Grove, IL 60515 | 2019-02-18 |
| 1538672449 | Wear Ltc | Pharmacy | 527 N Madison St Ste B, Carthage, IL 62321-1034 | 2017-11-14 |
| 1124546031 | Symbria Rx Services, LLC. | Pharmacy | 3200 Grant St Rm 41, Evanston, IL 60201-1903 | 2017-08-31 |
| 1699146720 | Pharmblue Illinois LLC | Pharmacy | 2960 Chartres St Ste 100, La Salle, IL 61301-1097 | 2015-10-15 |
| 1194144691 | Lifemed Illinois, LLC | Pharmacy | 881 Il Route 83, Bensenville, IL 60106-1219 | 2014-04-11 |
| 1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
| 1265863468 | Lake of Decatur, Inc | Pharmacy | 845 S Route 51, Unit B, Forsyth, IL 62535-9759 | 2013-12-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.