National Provider Identifier Database

WAUCONDA PHARMACY INC
Compounding Pharmacy

A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner?s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.


Contact Information

WAUCONDA PHARMACY INC
222 S MAIN ST
WAUCONDA, IL60084-1828
Phone: 847-526-2591
Fax: 847-526-1598
Website:
Specialty Taxonomy Code
* Compounding Pharmacy 3336C0004X
Community/Retail Pharmacy 3336C0003X
Durable Medical Equipment & Medical Supplies 332B00000X
Home Infusion Therapy Pharmacy 3336H0001X
Pharmacy 333600000X

* Indicates primary specialty

NPI Profile & details for WAUCONDA PHARMACY INC

NPI Number 1831274513
Legal business name
LBN
WAUCONDA PHARMACY INC
Authorized official TERRY BRUNER - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 10/25/2006
Last updated 11/07/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • IL License #: 054006291
  • IL Medicaid: 362686883001
  • Other: 1428196 OTHER ID NUMBER
  • IL Other: 1428196 BCBS PHARMACY
  • IL Other: IL3147 MEDICARE PART B

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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