Organization
MARENGO COMMUNITY PHARMACY INC
Active
Other names
Marengo Community Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
VIPUL PATEL (PRESIDENT/OWNER)
(630) 414-7747
Entity
Organization
Contact information
Practice address
20015 E GRANT HWY, MARENGO, IL 60152-8207
(815) 568-7866
(818) 568-7867
Mailing address
20015 E GRANT HWY, MARENGO, IL 60152-8207
(815) 568-7866
(818) 568-7867
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54-018044
IL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137101
PK
—
Enumeration date
07/05/2012
Last updated
09/19/2020
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