Healthcare Provider Details

I. General information

NPI: 1952442568
Provider Name (Legal Business Name): LINCOLN MEDICAL APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 S LINCOLN AVE
AURORA IL
60505-4264
US

IV. Provider business mailing address

157 S LINCOLN AVE
AURORA IL
60505-4264
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-7777
  • Fax: 630-892-7787
Mailing address:
  • Phone: 630-892-7777
  • Fax: 630-892-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number013884
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number13884
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN O'DWYER JR.
Title or Position: PRESIDENT
Credential:
Phone: 630-892-7777