NPIMap

Organization Active NPI

Provena Pharmacy Elgin

  • Community/Retail Pharmacy
  • Elgin, IL
National Provider Identifier
1811902455
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PROVENA PHARMACY ELGIN
Practice address
750 Fletcher Dr
Ste 103
Elgin, IL 60123-4703
Phone
(847) 931-5535
Fax
(849) 622-2072
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Satya Rao, RPH
Title
Dir of Phcy
Phone
(847) 695-3200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 54013758 IL
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

750 Fletcher Dr
Ste 103
Elgin, IL 60123-4703

Mailing address

750 Fletcher Dr
Ste 103
Elgin, IL 60123-4703

Other identifiers 1

IdentifierTypeStateIssuer
1460803OtherOTHER ID NUMBER-COMMERCIAL NUMBER

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Medcial Cente16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

750 Fletcher Dr
Ste 103
Elgin, IL 60123
Phone (847) 742-6700

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1811902455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 FLETCHER DR",
            "address_2": "STE 103",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FLETCHER DR",
            "address_2": "STE 103",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234703",
            "telephone_number": "847-931-5535",
            "fax_number": "849-622-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA PHARMACY ELGIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "RAO",
        "authorized_official_first_name": "SATYA",
        "authorized_official_title_or_position": "DIR OF PHCY",
        "authorized_official_telephone_number": "847-695-3200",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "IL",
            "license": "54013758",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1460803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.