Healthcare Provider Details

I. General information

NPI: 1316748270
Provider Name (Legal Business Name): LUX BOX RX L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 GLENWOOD AVE
ROCKFORD IL
61101
US

IV. Provider business mailing address

2821 GLENWOOD AVE SUITE 1
ROCKFORD IL
61101
US

V. Phone/Fax

Practice location:
  • Phone: 815-904-6951
  • Fax: 877-502-2250
Mailing address:
  • Phone: 508-736-2599
  • Fax:

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: DR. LUCIE DONIKIAN
Title or Position: OWNER
Credential: BCPC, PHARMD
Phone: 508-736-2599