Provider Demographics
NPI:1932806890
Name:WILGUS, CODY ADAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ADAM
Last Name:WILGUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16573 W APPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2471
Mailing Address - Country:US
Mailing Address - Phone:847-281-6692
Mailing Address - Fax:
Practice Address - Street 1:1300 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3724
Practice Address - Country:US
Practice Address - Phone:847-680-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist