Provider Demographics
NPI:1215538582
Name:WILMINGTON PHARMACY LLC
Entity Type:Organization
Organization Name:WILMINGTON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUELTZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:815-815-9261
Mailing Address - Street 1:600 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1281
Mailing Address - Country:US
Mailing Address - Phone:815-926-1770
Mailing Address - Fax:815-476-9476
Practice Address - Street 1:600 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1281
Practice Address - Country:US
Practice Address - Phone:815-926-1770
Practice Address - Fax:815-476-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy