1457953796 NPI number — CALLIE ELAINE GOEKE PHARM D.

Table of content: ASHLEY R HIMES (NPI 1437793619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457953796 NPI number — CALLIE ELAINE GOEKE PHARM D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEKE
Provider First Name:
CALLIE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457953796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 W SAINT LOUIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62896-2099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-937-2416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 W SAINT LOUIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62896-2099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-937-2416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051.298564 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PS59886 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 2015030935 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 051.298564 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051.298564 . This is a "IL LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".