Provider Demographics
NPI:1871581926
Name:D DIKO LLC
Entity type:Organization
Organization Name:D DIKO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMD/PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHIRKINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:815-872-3251
Mailing Address - Street 1:519 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2006
Mailing Address - Country:US
Mailing Address - Phone:815-872-3251
Mailing Address - Fax:815-872-1594
Practice Address - Street 1:519 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2006
Practice Address - Country:US
Practice Address - Phone:815-872-3251
Practice Address - Fax:815-872-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540198243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160617OtherPK
IL=========002Medicaid