Provider Demographics
NPI:1700039120
Name:BUBBLEPACK PHARMACY INC
Entity Type:Organization
Organization Name:BUBBLEPACK PHARMACY INC
Other - Org Name:BASINGER'S ESSINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONDAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-725-1102
Mailing Address - Street 1:2202 ESSINGTON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1634
Mailing Address - Country:US
Mailing Address - Phone:815-676-5320
Mailing Address - Fax:815-436-4586
Practice Address - Street 1:2202 ESSINGTON RD
Practice Address - Street 2:STE 104
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1634
Practice Address - Country:US
Practice Address - Phone:815-676-5320
Practice Address - Fax:815-436-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540170453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117582OtherPK
2117582OtherPK