Provider Demographics
NPI:1063557486
Name:BOUCHARD, DARCY D (RPH)
Entity type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:D
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 KNOX RD 1000 N
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61436
Mailing Address - Country:US
Mailing Address - Phone:309-289-2998
Mailing Address - Fax:
Practice Address - Street 1:1975 NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1488
Practice Address - Country:US
Practice Address - Phone:309-344-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist