Active NPI
PBCC Pharmacy LLC
- Pharmacy
- Springfield, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- PBCC PHARMACY LLC
- Practice address
- 1500 W Washington St Ste B
Springfield, IL 62702-4756 - Phone
- (217) 546-7100
- NPI assigned
- Apr 1, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Osvaldo Wesly
- Title
- Medical Director
- Phone
- (217) 414-1041
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Primary | ||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
1500 W Washington St Ste B
Springfield, IL 62702-4756
Mailing address
105 S Amos Ave
Springfield, IL 62704-1528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201028000273 | IL | Part B Supplier - Pharmacy | 0446660781 | Practice locations: Springfield, IL |
National Provider Directory
National Provider Directory- Tax ID family
- PBCC Pharmacy LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Springfield, IL
- NPI 1932845948
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Medical Oncology Physician
- Springfield, IL
- NPI 1356441943
-
- Pharmacist
- Springfield, IL
- NPI 1225650799
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585699200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1743984000000",
"number": "1366070476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 S AMOS AVE",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627041528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 W WASHINGTON ST STE B",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627024756",
"telephone_number": "217-546-7100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PBCC PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-04-01",
"last_updated": "2025-04-07",
"certification_date": "2025-04-07",
"status": "A",
"authorized_official_last_name": "WESLY",
"authorized_official_first_name": "OSVALDO",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "217-414-1041"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; 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.