Wilmington Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WILMINGTON PHARMACY LLC

Doing business as

Wilmington Pharmacy

Practice address

600 W Baltimore St
Wilmington, IL 60481-1281

Phone

(815) 926-1770

Fax

(815) 476-9476

NPI assigned

Nov 3, 2020

Last updated

Nov 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clarke Kueltzo, PHARMDNPI 1992960009

Title

President

Phone

(815) 815-9261

Specialties & licenses 1

Addresses

Other names 1

• Wilmington Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clarke Kueltzo, PHARMD.

  • Pharmacist
  • Lombard, IL
  • NPI 1992960009
  NPD Authorized official
• Eric Daniel Urbanowski, PHARM D

  • Pharmacist
  • Manteno, IL
  • NPI 1740440510
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1215538582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W BALTIMORE ST",
            "city": "WILMINGTON",
            "state": "IL",
            "postal_code": "604811281",
            "telephone_number": "815-926-1770",
            "fax_number": "815-476-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W BALTIMORE ST",
            "city": "WILMINGTON",
            "state": "IL",
            "postal_code": "604811281",
            "telephone_number": "815-926-1770",
            "fax_number": "815-476-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "KUELTZO",
        "authorized_official_first_name": "CLARKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-815-9261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilmington Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise D. Wilburn, MS, LCPC
• Willmington Nursing &Rehabilitation Center,L.L.C.
• Wilmington C U SCH Dist 209U
• Wilmington Chiropractic Inc
• Wilmington Fire Protection District
• Patrick John Yerkes, DDS
• Kimberly Irene Young

• Community/Retail Pharmacy in Wilmington, IL
• Providers in Wilmington, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.