Provider Demographics
NPI:1598014581
Name:UNITED RX, LLC
Entity Type:Organization
Organization Name:UNITED RX, LLC
Other - Org Name:UNITED RX, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO-CHIEF-OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-449-7600
Mailing Address - Street 1:120 N TOWER RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1929
Mailing Address - Country:US
Mailing Address - Phone:877-896-7090
Mailing Address - Fax:618-457-7407
Practice Address - Street 1:120 N TOWER RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1929
Practice Address - Country:US
Practice Address - Phone:877-896-7090
Practice Address - Fax:618-457-7407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-05
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540176533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487140OtherNCPDP
6381180001OtherDME PTAN
6381180001OtherDME PTAN
6381180001OtherDME PTAN