Provider Demographics
NPI:1366723868
Name:DERKS, DICK J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DICK
Middle Name:J
Last Name:DERKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S WABASH AVE
Mailing Address - Street 2:UNIT 4C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2256
Mailing Address - Country:US
Mailing Address - Phone:708-870-3674
Mailing Address - Fax:
Practice Address - Street 1:7251 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2238
Practice Address - Country:US
Practice Address - Phone:708-366-9960
Practice Address - Fax:708-366-1585
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist