Healthcare Provider Details

I. General information

NPI: 1366565962
Provider Name (Legal Business Name): BUBBLEPACK PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 ESSINGTON RD SUITE 104
JOLIET IL
60435-1634
US

IV. Provider business mailing address

2202 ESSINGTON RD SUITE 104
JOLIET IL
60435-1634
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-1102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number058013571
License Number StateIL

VIII. Authorized Official

Name: HEMANGINI THAKER
Title or Position: PRESIDENT
Credential:
Phone: 815-725-1102