Healthcare Provider Details

I. General information

NPI: 1053639328
Provider Name (Legal Business Name): SPECIALTY CARE RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 N SHERIDAN RD
CHICAGO IL
60640-2515
US

IV. Provider business mailing address

236 E JIMMIE LEEDS RD STE C SUITE C
GALLOWAY NJ
08205-4134
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-6200
  • Fax: 773-769-6207
Mailing address:
  • Phone: 855-927-0390
  • Fax: 855-927-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4872
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.018467
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number400-1760
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number64002423A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2017031357
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH31090
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNP000606
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNRP.022844200-03
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RO00126400
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2011-43
License Number StateWI

VIII. Authorized Official

Name: JOCELYN GOROKHOVSKY
Title or Position: PHARMACIST IN CHARGE
Credential: BS
Phone: 217-898-9951