Organization
WIGHTMAN PHARMACY INC
Active
Other names
WIGHTMAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE WIGHTMAN RPH (OWNER/PHARM)
(618) 939-6218
Entity
Organization
Contact information
Practice address
127 S MAIN ST, WATERLOO, IL 62298-1371
(618) 939-6218
(618) 939-4633
Mailing address
127 S MAIN ST, WATERLOO, IL 62298-1371
(618) 939-6218
(618) 939-4633
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054001471
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016696
PK
—
Enumeration date
07/16/2006
Last updated
04/06/2017
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