Provider Demographics
NPI:1447846902
Name:BOND COUNTY PHARMACY LLC
Entity type:Organization
Organization Name:BOND COUNTY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNTREGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-690-5000
Mailing Address - Street 1:224A E HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246
Mailing Address - Country:US
Mailing Address - Phone:618-690-5000
Mailing Address - Fax:
Practice Address - Street 1:224A E HARRIS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2150
Practice Address - Country:US
Practice Address - Phone:618-690-5000
Practice Address - Fax:618-703-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL54021820OtherPHARMACY LICENSE
1496694OtherNCPDP
1496694OtherNCPDP