Provider Demographics
NPI:1427142702
Name:DUPAGE COUNTY
Entity type:Organization
Organization Name:DUPAGE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-784-4275
Mailing Address - Street 1:400 N COUNTY FARM RD
Mailing Address - Street 2:RM G322
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3908
Mailing Address - Country:US
Mailing Address - Phone:630-784-4288
Mailing Address - Fax:630-784-4284
Practice Address - Street 1:400 N COUNTY FARM RD
Practice Address - Street 2:RM G322
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3908
Practice Address - Country:US
Practice Address - Phone:630-784-4288
Practice Address - Fax:630-784-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540173373336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021527OtherPK
2021527OtherPK
5193530001Medicare NSC