Provider Demographics
NPI:1497935878
Name:NUDAK VENTURES, LLC
Entity Type:Organization
Organization Name:NUDAK VENTURES, LLC
Other - Org Name:NUCARA PHARMACY COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACQUISTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:101 W VALLETTE ST
Mailing Address - Street 2:STE 140
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4419
Mailing Address - Country:US
Mailing Address - Phone:630-834-9768
Mailing Address - Fax:630-834-6643
Practice Address - Street 1:101 W VALLETTE ST
Practice Address - Street 2:STE 140
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4419
Practice Address - Country:US
Practice Address - Phone:630-834-9768
Practice Address - Fax:630-834-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0180383336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147106OtherPK