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NPI Code Detail

MEDICARE: BOND DRUG COMPANY OF ILLINOIS LLC

MEDICARE: BOND DRUG COMPANY OF ILLINOIS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy54008828IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11452185OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1427063643
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOND DRUG COMPANY OF ILLINOIS LLC
Provider Business Mailing Address
First Line : 1901 E VOORHEES
Second Line : MS 790
City : DANVILLE
State : IL
Zip : 61834-4509
Country : US
Telephone Number : 217-709-2386
Fax Number : 217-709-2344
Provider Business Practice Location Address
First Line : 240 W RANDOLPH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60606-1812
Country : US
Telephone Number : 312-263-7499
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : MR. ALAN NIELSEN
Credential :
Telephone Number : 847-315-3523
Provider Enumeration Date : 07/29/2006
Last Update Date : 04/05/2017

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Directions to “BOND DRUG COMPANY OF ILLINOIS LLC ” Practice Location

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