Provider Demographics
NPI:1053639328
Name:SPECIALTY CARE RX LLC
Entity Type:Organization
Organization Name:SPECIALTY CARE RX LLC
Other - Org Name:CUREXA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROKHOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:217-898-9951
Mailing Address - Street 1:236 E JIMMIE LEEDS RD STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4134
Mailing Address - Country:US
Mailing Address - Phone:855-927-0390
Mailing Address - Fax:855-927-0392
Practice Address - Street 1:5310 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2515
Practice Address - Country:US
Practice Address - Phone:773-769-6200
Practice Address - Fax:773-769-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4872333600000X
IL054.0184673336C0003X
SD400-17603336C0003X
IN64002423A3336C0003X
MO20170313573336C0003X
FLPH310903336C0003X
PANP0006063336C0003X
OHNRP.022844200-033336C0003X
NJ28RO001264003336C0003X
WI2011-433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144078OtherPK
2144078OtherPK