Healthcare Provider Details

I. General information

NPI: 1902569676
Provider Name (Legal Business Name): SYMBRIA RX GREAT LAKES SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 23RD STREET EXT STE 164
SHARPSBURG PA
15215-2821
US

IV. Provider business mailing address

7125 JANES AVE STE 300
WOODRIDGE IL
60517-2304
US

V. Phone/Fax

Practice location:
  • Phone: 724-545-1600
  • Fax:
Mailing address:
  • Phone: 630-413-5800
  • Fax: 630-413-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEREK BROWN
Title or Position: VICE PRESIDENT OF PHARMACY
Credential:
Phone: 630-981-8150