Provider Demographics
NPI:1275754798
Name:WELLRX LLC
Entity Type:Organization
Organization Name:WELLRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:877-629-4446
Mailing Address - Street 1:200 E WILLOW AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5463
Mailing Address - Country:US
Mailing Address - Phone:877-629-4446
Mailing Address - Fax:877-599-0139
Practice Address - Street 1:200 E WILLOW AVE
Practice Address - Street 2:STE 100
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5463
Practice Address - Country:US
Practice Address - Phone:877-629-4446
Practice Address - Fax:877-599-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54020427333600000X, 3336H0001X, 3336S0011X
IL0540020673336C0003X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157822OtherPK
IL36-2789201-0003Medicaid
0229650002Medicare NSC