Provider Demographics
NPI:1760088223
Name:MEDWIZ OF ILLINOIS LLC
Entity Type:Organization
Organization Name:MEDWIZ OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-825-9089
Mailing Address - Street 1:167 ROUTE 304 STE 101
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2050
Mailing Address - Country:US
Mailing Address - Phone:845-624-8080
Mailing Address - Fax:845-624-8055
Practice Address - Street 1:940 S FRONTAGE RD STE 400
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4953
Practice Address - Country:US
Practice Address - Phone:630-866-6400
Practice Address - Fax:630-866-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy