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General NPI Number Information
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NPI Number | 1215538582
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Entity Type | Organization
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Legal Business Name | WILMINGTON PHARMACY LLC
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 600 W BALTIMORE ST
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City | WILMINGTON
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State | IL
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Zip | 60481-1281
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Country | US
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Telephone | 815-926-1770
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Fax | 815-476-9476
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Provider Business Mailing Address
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Address Line | 600 W BALTIMORE ST
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City | WILMINGTON
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State | IL
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Zip | 60481-1281
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Country | US
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Telephone | 815-926-1770
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Fax | 815-476-9476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLARKE KUELTZO
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Credential | PHARMD
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Telephone | 815-815-9261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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