Wauconda Pharmacy Inc

LBN: Wauconda Pharmacy Inc
Wauconda Pharmacy Inc is an health care organization with primary practice located at 222 S Main St , Wauconda IL 60084-1828. The organization recently has 5 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy, Suppliers / Home Infusion Therapy Pharmacy. Suppliers / Compounding Pharmacy is the primary health care specialty. Wauconda Pharmacy Inc can be contacted via phone (847) 526-2591, or through Bruner, Terry via phone (847) 526-2591.

Contact Information

Primary practice address
222 S Main St Wauconda IL 60084-1828
Phone: (847) 526-2591
Fax: (847) 526-1598
Website:
Map and Directions
Authorized official contact:
Name: Bruner, Terry RPH
Phone: (847) 526-2591

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X
Suppliers / Compounding Pharmacy 3336C0004X 054006291 Illinois
Suppliers / Home Infusion Therapy Pharmacy 3336H0001X

Profile Details

NPI number 1831274513
LBN Legal business name Wauconda Pharmacy Inc
DBA Doing business as
Authorized official Bruner, Terry RPH
Entity Organization
Organization subpart 1 No
Enumeration date Oct 25th, 2006
Last updated Nov 7th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831274513 NPPES
Illinois Other 1428196 BCBS PHARMACY
Illinois Other IL3147 BCBS PHARMACY
Illinois Other 1428196 BCBS PHARMACY
Illinois MEDICAID 362686883001 BCBS PHARMACY

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