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General NPI Number Information
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NPI Number | 1669755484
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Entity Type | Organization
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Legal Business Name | BOND DRUG COMPANY OF ILLINOIS, L.L.C.
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 07/28/2012
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Provider Practice Location Address
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Address Line | 780 WAUKEGAN RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4305
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Country | US
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Telephone | 847-945-0611
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Fax | 847-945-5978
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Provider Business Mailing Address
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Address Line | 780 WAUKEGAN RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4305
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Country | US
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Telephone | 847-945-0611
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Fax | 847-945-5978
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Authorized Official
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Title or Position | PHARMACIST/PHARMACY MANAGER
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Name | MRS. ZHANNA E LACROIX
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Credential | RPH
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Telephone | 847-945-0611
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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 | 051288387
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License Number State | IL
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