MEDICARE: SUPERIOR RX INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	054-010090	IL

General Provider Information

NPI Number	:	1568453611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR RX INC.

Provider Business Mailing Address
First Line	:	801 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3009
Country	:	US
Telephone Number	:	773-525-0081
Fax Number	:	773-525-0095

Provider Business Practice Location Address
First Line	:	801 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3009
Country	:	US
Telephone Number	:	773-525-0081
Fax Number	:	773-525-0095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD DAVID RAMBO
Credential	:	RPH MBA
Telephone Number	:	773-525-0081

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	04/20/2008

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