Active NPI
Kenneth Mark Bodenhagen, PHARM D
- Pharmacist
- Bolingbrook, IL
National Provider Identifier
1013983105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- Practice address
- 225 N Weber Rd
Bolingbrook, IL 60490-1505 - Phone
- (630) 679-6533
- Fax
- (630) 679-6565
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | IL | Primary |
Addresses
Primary practice location
225 N Weber Rd
Bolingbrook, IL 60490-1505
Mailing address
13963 S Trails End Dr
Homer Glen, IL 60491-8643
Phone (708) 645-1678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-286078 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1013983105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13963 S TRAILS END DR",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604918643",
"telephone_number": "708-645-1678",
"fax_number": "630-679-6565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 N WEBER RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604901505",
"telephone_number": "630-679-6533",
"fax_number": "630-679-6565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODENHAGEN",
"first_name": "KENNETH",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.