Provider Demographics
NPI:1871845776
Name:VORAC PHARMACY LLC
Entity Type:Organization
Organization Name:VORAC PHARMACY LLC
Other - Org Name:VORAC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VORAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-944-2166
Mailing Address - Street 1:114 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1348
Mailing Address - Country:US
Mailing Address - Phone:309-944-2166
Mailing Address - Fax:309-944-3574
Practice Address - Street 1:114 S STATE ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1348
Practice Address - Country:US
Practice Address - Phone:309-944-2166
Practice Address - Fax:309-944-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540187793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL307027502001Medicaid
2150301OtherPK
2150301OtherPK