Healthcare Provider Details

I. General information

NPI: 1275754798
Provider Name (Legal Business Name): WELLRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WILLOW AVE STE 100
WHEATON IL
60187-5463
US

IV. Provider business mailing address

200 E WILLOW AVE STE 100
WHEATON IL
60187-5463
US

V. Phone/Fax

Practice location:
  • Phone: 877-629-4446
  • Fax: 877-599-0139
Mailing address:
  • Phone: 877-629-4446
  • Fax: 877-599-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54020427
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054002067
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number54020427
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number54020427
License Number StateIL

VIII. Authorized Official

Name: SCOTT LUCKOW
Title or Position: OWNER/MANAGER
Credential: PHARMD
Phone: 877-629-4446