NPI 1114775897 · live from the CMS NPI Registry
1918 Winter Street Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Crystal Lake, IL. National Provider Identifier 1114775897, active.
NPI record
| NPI | 1114775897 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 105 Northwest Hwy, Crystal Lake, IL 60014 |
| Practice phone | 815-261-4733 |
| Mailing address | 7 Corporate Dr, Keene, NH 03431 |
| Enumerated | May 8, 2024 |
| Last updated | July 24, 2024 |
| Authorized official | Kevin Mcnamara, Authorized Person |
| Other names | Mariano'S Pharmacy #0544 |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | — |
| Pharmacy, Community/Retail Pharmacy primary | 3336C0003X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.