Healthcare Provider Details

I. General information

NPI: 1417206434
Provider Name (Legal Business Name): JRD-RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001C W CERMAK RD
CICERO IL
60804-2018
US

IV. Provider business mailing address

9680 GOLF RD FL 2
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 708-987-3795
  • Fax: 847-352-0423
Mailing address:
  • Phone: 708-987-3795
  • Fax: 847-352-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN WILLIAM SALDANHA
Title or Position: MANAGER
Credential:
Phone: 708-987-3795