CYSTIC FIBROSIS SERVICES LLC

Provider Demographics

• NPI: 1477571404
• Name: CYSTIC FIBROSIS SERVICES LLC
• Entity type: Organization
• Organization Name: CYSTIC FIBROSIS SERVICES LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: MANAGER
• Authorized Official - First Name: JENNIFER
• Authorized Official - Last Name: PONCE
• Authorized Official - Phone: 847-527-2489
• Mailing Address - Street 1: 1901 E VOORHEES ST
• Mailing Address - Street 2: MS 790
• Mailing Address - City: DANVILLE
• Mailing Address - State: IL
• Mailing Address - Zip Code: 61834-4509
• Mailing Address - Country: US
• Mailing Address - Phone: 217-709-2386
• Mailing Address - Fax: 217-709-2344
• Practice Address - Street 1: 10530 JOHN W ELLIOTT DR
• Practice Address - Street 2: STE 200
• Practice Address - City: FRISCO
• Practice Address - State: TX
• Practice Address - Zip Code: 75033
• Practice Address - Country: US
• Practice Address - Phone: 800-541-4959
• Practice Address - Fax: 866-574-1418
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: WALGREENS BOOTS ALLIANCE
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-07-17
• Last Update Date: 2024-11-11

Provider Licenses

State	License ID	Taxonomies
		3336H0001X, 3336S0011X
TX	22618	3336M0002X, 332B00000X
TX	29801	333600000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	333600000X	Suppliers	Pharmacy
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	0072006850007	Medicaid
NJ	0510131	Medicaid
AK	1028469	Medicaid
VA	1477571404	Medicaid
WA	2041124	Medicaid
OR	500678751	Medicaid
OK	100798300D	Medicaid
LA	1279595	Medicaid
TX	145295	Medicaid
KS	100443180B	Medicaid
MN	1477571404	Medicaid
NV	1477571404	Medicaid
ID	1477571404	Medicaid
CT	1477571404	Medicaid
CO	21576777	Medicaid
OH	0105009	Medicaid
DC	082243600	Medicaid
	4528874	Other	NCPDP
IA	0761528	Medicaid
SD	1477571404	Medicaid
IN	201273550A	Medicaid
WI	100043530	Medicaid
WY	139071600	Medicaid
CA	1477571404	Medicaid
MI	1477571404	Medicaid
KY	7100162130	Medicaid
MT	0215203	Medicaid
NM	05779731	Medicaid
NE	100264738-00	Medicaid
UT	1477571404	Medicaid
AR	152683407	Medicaid
TN	4528874	Medicaid
SC	7T2618	Medicaid
AZ	967893	Medicaid
VT	1030442	Medicaid
NH	3099359	Medicaid
MD	5124191-00	Medicaid
NE	100264738-00	Medicaid
UT	1477571404	Medicaid