Healthcare Provider Details

I. General information

NPI: 1700039120
Provider Name (Legal Business Name): BUBBLEPACK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 ESSINGTON RD STE 104
JOLIET IL
60435-1634
US

IV. Provider business mailing address

2202 ESSINGTON RD STE 104
JOLIET IL
60435-1634
US

V. Phone/Fax

Practice location:
  • Phone: 815-676-5320
  • Fax: 815-436-4586
Mailing address:
  • Phone: 815-676-5320
  • Fax: 815-436-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054017045
License Number StateIL

VIII. Authorized Official

Name: CONNIE SONDAG
Title or Position: MANAGER
Credential:
Phone: 815-725-1102