Bolingbrook Pharmacy Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

054005594 Issued in IL

Legal business name

BOLINGBROOK PHARMACY INC

Practice address

402 W Boughton Rd
Ste C
Bolingbrook, IL 60440-1872

Phone

(630) 759-6464

Fax

(630) 759-1780

NPI assigned

Sep 12, 2006

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

RPH/Owner

Phone

(630) 759-6464

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• BOLINGBROOK PHARMACY INC Doing business as

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1912001967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD",
            "address_2": "STE C",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401872",
            "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",
            "address_2": "STE C",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401872",
            "telephone_number": "630-759-6464",
            "fax_number": "630-759-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLINGBROOK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "SINGLETARY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "RPH/OWNER",
        "authorized_official_telephone_number": "630-759-6464"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "IL",
            "license": "054005594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022733",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOLINGBROOK PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Jan 18, 2017; 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.