Provider Demographics
NPI:1356843072
Name:ADVANCED CARE RX LLC
Entity Type:Organization
Organization Name:ADVANCED CARE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:312-462-0071
Mailing Address - Street 1:11422 S WESTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4120
Mailing Address - Country:US
Mailing Address - Phone:312-834-5293
Mailing Address - Fax:
Practice Address - Street 1:11422 S WESTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4120
Practice Address - Country:US
Practice Address - Phone:312-834-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0206543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy