Main Street Pharmacy

LBN: Douglas & Ogden Medical Center Pharmacy Inc
Main Street Pharmacy is an health care organization with primary practice located at 24 W First St , Manteno IL 60950-1239. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Douglas & Ogden Medical Center Pharmacy Inc can be contacted via phone (630) 969-0036, or through Kueltzo, Clarke Allan via phone (630) 969-0036.

Contact Information

Primary practice address
24 W First St Manteno IL 60950-1239
Phone: (630) 969-0036
Fax: (630) 852-6545
Website:
Map and Directions
Authorized official contact:
Name: Kueltzo, Clarke Allan PHARMD
Phone: (630) 969-0036

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 054009256 Illinois
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1760543581
LBN Legal business name Douglas & Ogden Medical Center Pharmacy Inc
DBA Doing business as Main Street Pharmacy
Authorized official Kueltzo, Clarke Allan PHARMD
Entity Organization
Organization subpart 1 No
Enumeration date Dec 13th, 2006
Last updated Jun 12th, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760543581 NPPES
Other 2019413 PK

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