Organization
CLEAR CREEK PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY BUIKEMA (OWNER)
(877) 527-0909
Entity
Organization
Contact information
Practice address
19015 S JODI RD STE A, MOKENA, IL 60448-8534
(877) 527-0909
Mailing address
19015 S JODI RD STE A, MOKENA, IL 60448-8534
(877) 527-0909
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054.022068
STATE LICENSE NUMBER
IL
Enumeration date
04/15/2022
Last updated
04/15/2022
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