# WIGHTMAN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WIGHTMAN PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831116763
- **Authorized official:** STEVE WIGHTMAN RPH (OWNER/PHARM)
- **Authorized official phone:** (618) 939-6218

## Contact information

- **Practice address:** 127 S MAIN ST, WATERLOO, IL 62298-1371
- **Practice address phone:** (618) 939-6218
- **Practice address fax:** (618) 939-4633
- **Mailing address:** 127 S MAIN ST, WATERLOO, IL 62298-1371
- **Mailing address phone:** (618) 939-6218
- **Mailing address fax:** (618) 939-4633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054001471 | IL | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 04/06/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2016696 | PK | — |