WAUCONDA PHARMACY INC. NPI 1568571420

NPI Information

NPI: 1568571420
Provider Name: WAUCONDA PHARMACY, INC.

Doing Business As: VITAL CARE OF WAUCONDA

Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
Entity Type: Organization
Address:
222 S MAIN ST
WAUCONDA, IL
ZIP 60084
Phone: (847) 526-2591
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WAUCONDA PHARMACY, INC. is a durable medical equipment medical supplies in Wauconda, IL. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. WAUCONDA PHARMACY, INC. NPI is 1568571420. The provider is registered as an organization entity type.
The provider Is Doing Business As Vital Care Of Wauconda.

The provider's business location address is:

222 S MAIN ST
WAUCONDA, IL
ZIP 60084-828
Phone: (847) 526-2591
Fax: (847) 526-1598

The provider's authorized official is Terry J Bruner .
The authorized official title is Manager and has the following contact phone number (847) 526-2591.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 11/7/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332BC3200X	Durable Medical Equipment & Medical Supplies	Customized Equipment	054-006291	ILLINOIS	No
2	332BP3500X	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition	054-006291	ILLINOIS	No
3	332BX2000X	Durable Medical Equipment & Medical Supplies	Oxygen Equipment & Supplies	054-006291	ILLINOIS	No
4	333600000X	Pharmacy		054-006291	ILLINOIS	No
5	3336C0003X	Pharmacy	Community/Retail Pharmacy	054-006291	ILLINOIS	No
6	3336H0001X	Pharmacy	Home Infusion Therapy Pharmacy	054-006291	ILLINOIS	No
7	3336L0003X	Pharmacy	Long Term Care Pharmacy	054-006291	ILLINOIS	No
8	3336M0002X	Pharmacy	Mail Order Pharmacy	054-006291	ILLINOIS	No
9	3336S0011X	Pharmacy	Specialty Pharmacy	054-006291	ILLINOIS	No
10	332B00000X	Durable Medical Equipment & Medical Supplies		054-006291	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1259900001	MEDICARE NSC
2	1428196	OTHER	ILLINOIS	BCBS PHARMACY
3	IL3147	OTHER	ILLINOIS	MEDICARE PART B
4	36368683001	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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