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General NPI Number Information
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NPI Number | 1376433565
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Entity Type | Organization
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Legal Business Name | SUPERIOR LTC RX LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1212 BEAR LN
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City | MONTICELLO
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State | IL
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Zip | 61856-9581
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Country | US
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Telephone | 217-762-3950
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 BEAR LN
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City | MONTICELLO
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State | IL
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Zip | 61856-9581
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Country | US
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Telephone | 217-762-3950
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MS. REGAN MILLER
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Credential |
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Telephone | 217-762-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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