Provider Demographics
NPI:1568894749
Name:UNITED/XCEL-RX LLC
Entity Type:Organization
Organization Name:UNITED/XCEL-RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC-PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-564-5052
Mailing Address - Street 1:150 FENCL LN STE 2B
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2041
Mailing Address - Country:US
Mailing Address - Phone:708-564-5052
Mailing Address - Fax:708-564-5130
Practice Address - Street 1:150 FENCL LN STE 2B
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2041
Practice Address - Country:US
Practice Address - Phone:708-564-5052
Practice Address - Fax:708-564-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540180743336C0003X
IL054.0204603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy