Bolingbrook Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

054005594 Issued in IL

Legal business name

BOLINGBROOK COMPOUNDING PHARMACY

Doing business as

Bolingbrook Compounding Pharmacy

Practice address

402 W Boughton Rd Ste C
Bolingbrook, IL 60440-1985

Phone

(630) 759-6464

Fax

(630) 759-1780

NPI assigned

Apr 1, 2014

Last updated

Apr 1, 2014By 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

John Singletary

Title

Owner/Pharmacist

Phone

(630) 759-6464

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bolingbrook Compounding Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396310400000",
    "number": "1588082127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD STE C",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401985",
            "telephone_number": "630-759-6464",
            "fax_number": "630-759-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD STE C",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401985",
            "telephone_number": "630-759-6464",
            "fax_number": "630-759-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLINGBROOK COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2014-04-01",
        "status": "A",
        "authorized_official_last_name": "SINGLETARY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "630-759-6464"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "IL",
            "license": "054005594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144727",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolingbrook Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth Mark Bodenhagen, PHARM D
• Michael Boerst
• Oladunni F Boladale, DNP
• Nicole A Boler, MD
• Katie Bolf, ATC
• Bolingbrook Dental Associates LLC
• Bolingbrook Dental Care
• Bolingbrook Eye Care & Eyewear Gallery, LLC
• Bolingbrook Eye Specialists LTD
• Bolingbrook Family Chiropractic LTD (Bolingbrook Family Chiropractic)

• Compounding Pharmacy in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Compounding Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.