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General NPI Number Information
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NPI Number | 1518852003
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Entity Type | Organization
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Legal Business Name | SRX COMPOUNDING AND WELLNESS LLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 2450 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1884
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Country | US
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Telephone | 773-525-0766
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1884
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Country | US
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Telephone | 773-525-0766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES KOLAR
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Credential |
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Telephone | 773-499-9973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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