NPIMap

Organization Active NPI

Thies-Lombard Pharmacy, Inc

  • Pharmacy
  • Lombard, IL
National Provider Identifier
1467442673
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
54-4487 Issued in IL
Legal business name
THIES-LOMBARD PHARMACY, INC
Doing business as
Lombard Pharmacy, Inc
Practice address
211 S Main St
Lombard, IL 60148-2678
Phone
(630) 495-2333
Fax
(630) 495-2355
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mr. Clarke Allan Kueltzo, PHARMD
Title
President
Phone
(630) 495-2333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 54-4487 IL
Pharmacy 333600000X 54-4487 IL Primary

Addresses

Primary practice location

211 S Main St
Lombard, IL 60148-2678

Mailing address

211 S Main St
Lombard, IL 60148-2678
Phone (630) 495-2333

Other identifiers 1

IdentifierTypeStateIssuer
1408574OtherILNCPDP PROVIDER ID

Other names 1

  • Lombard Pharmacy, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091008000214 IL Part B Supplier - Mass Immunization (Roster Biller Only) 1850437641 Practice locations: Lombard, IL
O20100930037132 IL DME Supplier - PharmacyDME Supplier - Orthotic PersonnelDME Supplier - Medical Supply Company With Registered Pharmacist 1850437641 Practice locations: Lombard, IL

National Provider Directory

National Provider Directory
Tax ID family
Lombard Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1467442673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S MAIN ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482678",
            "telephone_number": "630-495-2333",
            "fax_number": "630-495-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S MAIN ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482678",
            "telephone_number": "630-495-2333",
            "fax_number": "630-495-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIES-LOMBARD PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2023-03-07",
        "certification_date": "2022-06-18",
        "status": "A",
        "authorized_official_last_name": "KUELTZO",
        "authorized_official_first_name": "CLARKE",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-495-2333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "54-4487",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54-4487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER ID",
            "identifier": "1408574",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lombard Pharmacy, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lombard Pharmacy, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.