# MARENGO COMMUNITY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Marengo Community Pharmacy Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114282266
- **Authorized official:** VIPUL PATEL (PRESIDENT/OWNER)
- **Authorized official phone:** (630) 414-7747

## Contact information

- **Practice address:** 20015 E GRANT HWY, MARENGO, IL 60152-8207
- **Practice address phone:** (815) 568-7866
- **Practice address fax:** (818) 568-7867
- **Mailing address:** 20015 E GRANT HWY, MARENGO, IL 60152-8207
- **Mailing address phone:** (815) 568-7866
- **Mailing address fax:** (818) 568-7867

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 54-018044 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/05/2012
- **Last updated:** 09/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2137101 | PK | — |