Healthcare Provider Details

I. General information

NPI: 1285970574
Provider Name (Legal Business Name): NORTHERN RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 E. NW HWY.
ARLINGTON HEIGHTS IL
60004
US

IV. Provider business mailing address

2012 E. NW HWY.
ARLINGTON HEIGHTS IL
60004
US

V. Phone/Fax

Practice location:
  • Phone: 314-498-0504
  • Fax:
Mailing address:
  • Phone: 314-498-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KEN SMITH
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D,
Phone: 314-498-0504