Provider Demographics
NPI:1952442568
Name:LINCOLN MEDICAL APOTHECARY, INC.
Entity Type:Organization
Organization Name:LINCOLN MEDICAL APOTHECARY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DWYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:630-892-7777
Mailing Address - Street 1:157 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4264
Mailing Address - Country:US
Mailing Address - Phone:630-892-7777
Mailing Address - Fax:630-892-7787
Practice Address - Street 1:157 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4264
Practice Address - Country:US
Practice Address - Phone:630-892-7777
Practice Address - Fax:630-892-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL013884333600000X
IL138843336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid