Healthcare Provider Details

I. General information

NPI: 1760805089
Provider Name (Legal Business Name): SPECIALTY CARE RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 N SHERIDAN RD
CHICAGO IL
60640-2514
US

IV. Provider business mailing address

5310 N SHERIDAN RD
CHICAGO IL
60640-2514
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-6200
  • Fax: 773-769-6201
Mailing address:
  • Phone: 773-769-6200
  • Fax: 773-769-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054018467
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number054018467
License Number StateIL

VIII. Authorized Official

Name: KEITH P HARTMAN
Title or Position: CEO
Credential: RPH
Phone: 609-457-0814