Provider Demographics
NPI:1568453611
Name:SUPERIOR RX INC.
Entity Type:Organization
Organization Name:SUPERIOR RX INC.
Other - Org Name:SUTCLIFFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:773-525-0081
Mailing Address - Street 1:801 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3009
Mailing Address - Country:US
Mailing Address - Phone:773-525-0081
Mailing Address - Fax:773-525-0095
Practice Address - Street 1:801 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3009
Practice Address - Country:US
Practice Address - Phone:773-525-0081
Practice Address - Fax:773-525-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-010090333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4606200001Medicare NSC