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General NPI Number Information
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NPI Number | 1114282266
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Entity Type | Organization
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Legal Business Name | MARENGO COMMUNITY PHARMACY INC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 20015 E GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-8207
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Country | US
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Telephone | 815-568-7866
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Fax | 818-568-7867
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Provider Business Mailing Address
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Address Line | 20015 E GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-8207
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Country | US
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Telephone | 815-568-7866
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Fax | 818-568-7867
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VIPUL PATEL
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Credential |
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Telephone | 630-414-7747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54-018044
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License Number State | IL
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